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congenital adrenal hyperplasia ( cah ) refers to a group of autosomal recessive disorders caused by an enzyme deficiency which leads to defects in biosynthesis of steroid precursors . depending on the severity and degree of 21 hydroxylase deficiency , the clinical spectrum may vary from mild form of non classical cah t... | congenital adrenal hyperplasia is a group of autosomal recessive disorders caused by enzyme deficiency which leads to defects in biosynthesis of steroid precursors .
most common is 21 hydroxylase deficiency .
clinical spectrum varies from non - classical cah to classic cah , and it may be simple virilising form or ... |
the femoral head often leads to healing complications , while the more predictable prosthetic replacements are associated with poorer function and significant complications . the treatment of these fractures depends on the age of the patient , fracture displacement , bone quality , timing of surgery and activity level ... | fracture of the femoral neck continues to be a vexing clinical and therapeutic challenge for the orthopedic surgeon .
the fracture has a propensity for non - union and avascular necrosis .
it is a challenge for the orthopedic surgeon to decide when to intervene in a case with non - union where the implant continues... |
granuloma faciale ( gf ) is an uncommon , benign , inflammatory skin disorder of unknown etiology . it is characterized by single or multiple , grey - brown or violaceous nodules or plaques primarily occurring on the face and occasionally at extra - facial sites . the disease is notoriously resistant to therapies and o... | granuloma faciale ( gf ) is a chronic condition characterized by red - brown plaques with follicular accentuation present usually on the face .
we present a case of 35-year - old female with 5 year history of plaques over cheek and extra facial sites consistent with gf and its response to topical tacrolimus .
this ... |
chronic myelomonocytic leukaemia ( cmmol ) is a rare disease with an incidence of 0.370.72 per 100 000 population . the median age at diagnosis varies between 65 years and 75 years [ 14 ] . the radical treatment is allogeneic stem cell transplantation , although this treatment is unsuitable for most patients because of... | we report a case of chronic myelomonocytic leukaemia ( cmmol ) in a 68-year - old man who developed osteomyelitis of the mandible . at the initial visit
, he reported uncontrolled gingival bleeding , despite self - administered haemostasis .
he complained of severe pain in the socket , despite potent opioid analges... |
in a recent issue of critical care , we presented a series of 13 patients undergoing post - cardiotomy extracorporeal membrane oxygenation ( ecmo ) with bivalirudin - based anticoagulation . after this series , we satisfactorily continued this experience , reaching about 20 patients treated . however , we think that a ... | bivalirudin has been proposed as the sole anticoagulant in patients under extracorporeal membrane oxygenation ( ecmo ) or cardiopulmonary bypass .
owing to the pharmacodynamic properties of bivalirudin , areas of blood stagnation should be carefully avoided in order to limit the risk of thrombosis .
the ecmo circui... |
ureterocele is a congenital urinary abnormality characterized by the presence of an intrabladder hernia or cystic ballooning of the lower end of a ureter lying between the mucosa and muscle of the bladder . the abnormality leads to urinary retention and recurrent urinary tract infection ( uti ) , which can cause irreve... | ureterocele is a common ureteric anomaly detected in pediatric population .
ureterocele diagnosis and evaluation need a variety of radiological methods .
we report a case of 5-year - old female child sent for 99mtc - diethylene triamine pentaacetic acid scan for evaluation of glomerular filtration rate and excretor... |
septic arthritis of the shoulder is uncommon in adults . it is a surgical emergency as joint destruction occurs rapidly and can lead to significant morbidity and mortality . a 43 years old male came to our outpatient department with complaints of pain and stiffness of his left shoulder . on examination , his shoulder m... | introduction : septic arthritis of the shoulder is uncommon in adults . it is a surgical emergency as joint destruction occurs rapidly and can lead to significant morbidity and mortality .
accurate diagnosis can be particularly challenging in patients with underlying liver disease .
mri is a useful adjunct in early... |
tuberculosis ( tb ) is a major health issue in developing countries with over two billion people being infected with tuberculosis bacilli world wide ( 1 ) . although tb was recently regarded primarily as a disease of the developing countries it is now also on the increase in developed countries such as the united kingd... | tuberculosis ( tb ) is a major health issue in both developing and developed countries such as the uk .
healthy individuals who contract the infection have only 5 - 10% chance of converting to the active disease over their lifetime .
we present the clinical history of a 76 year old female who attended the emergency... |
brachial plexus surgery using the da vinci surgical robot is a new procedure . to evaluate the advantages and the restrictions of the technique , a cadaveric study of supraclavicular and axillary approaches was conducted . we found that the axillary approach was useful and advantageous for lower roots , particularly fo... | brachial plexus surgery using the da vinci surgical robot is a new procedure .
although the supraclavicular approach is a well known described and used procedure for robotic surgery , axillary approach was unknown for brachial plexus surgery .
a cadaveric study was planned to evaluate the robotic axillary approach ... |
gossypiboma ( retained surgical sponge ) describes a mass of cotton or sponge that is left behind in the body cavity during a surgical operation . these foreign bodies can often mimic tumors or abscesses when detected clinically or with radiation . in fact , surgical sponges without opaque markers are the leading cause... | gossypiboma is a term used to describe a foreign mass within the body that is composed of a cotton matrix .
gossypiboma can cause infection or abscess formation from an early stage , or it can remain clinically silent for many years .
gossypiboma can be diagnosed using several methods including abdominal x - ray fi... |
to demonstrate the usefulness of enhanced depth imaging optical coherence tomography ( edi - oct ) in investigating choroidal lesions inaccessible to ultrasound sonography . in a 60-year - old woman with an asymptomatic choroidal nevus , normal oct was used to observe the macula and edi - oct to image the choroidal nev... | purposeto demonstrate the usefulness of enhanced depth imaging optical coherence tomography ( edi - oct ) in investigating choroidal lesions inaccessible to ultrasound sonography.methodsin a 60-year - old woman with an asymptomatic choroidal nevus , normal oct was used to observe the macula and edi - oct to image the c... |
a 3-year - old male , known to have isolated speech delay , presented to the emergency department with severe body aches and inability to walk . few days prior to his presentation , the child started to have flu - like symptoms in the form of rhinorrhea and low - grade fever . this was followed by irritableness , hypoa... | rhabdomyolysis is an acute life - threatening condition that can occur in childhood secondary to many causes .
the authors report the case of a 3-year - old male child who presented with acute rhabdomyolysis .
the peak plasma creatine kinase level was extremely high .
the 2 main causes of rhabdomyolysis in childh... |
malaligned implants often complicate the clinical laboratory procedures employed for fabrication of superstructures . due to improper load distribution , a stent is an appliance used for radiographic evaluation of height and width of the available bone during treatment planning for implant placement or during surgical ... | aim : demand from implant patients for quality and efficient treatment is increasing .
fortunately dental implant treatment is evolving with patients expectations.materials and methods : the study comprised of 45 patients for whom 89 implants were placed at different sites .
efficacy of the stents is evaluated in d... |
neurofibromatosis ( nf ) is an autosomal dominant disease , discovered in 1882 , by the german pathologist friedrich daniel von recklinghausen , characterized by disordered growth of ectodermal tissues , and is part of a group of disorders called phakomatoses ( neurocutaneous syndrome ) . neurofibromatosis type - i ( n... | segmental neurofibromatosis is a rare disorder , characterized by neurofibromas or caf-au - lait macules limited to one region of the body .
its occurrence on the face is extremely rare and only few cases of segmental neurofibromatosis over the face have been described so far .
we present a case of segmental neurof... |
patient aged 64 was admitted to the county hospital urology ward in september 2010 and diagnosed with tumor of the left kidney . ultrasonographic exam revealed the structure with a diameter of 45 mm in the central field of the left kidney . ct showed a solid focal lesion of the left kidney ( 30 x 40 x 32 mm ) located b... | we present a 64year old patient suffering from extranodal malignant lymphoma .
the patient was admitted to the county hospital urology ward with suspicion of the left kidney tumor . as part of pre
operational diagnosis , ultrasonographic examination and computed tomography of kidneys were conducted .
the results... |
a young man was referred with a chief complaint of blurred vision and pain of the left eye 1 month after herpetic encephalitis in the left frontotemporal lobe . the patient had multiple foci of retinitis in the retinal periphery associated with vitritis , blot retinal hemorrhage and retinal arteriolitis . the impressio... | purposeto report a case of unilateral acute retinal necrosis after herpetic encephalitiscase reporta young man was referred with a chief complaint of blurred vision and pain of the left eye 1 month after herpetic encephalitis in the left frontotemporal lobe .
the patient had multiple foci of retinitis in the retinal ... |
an infliction in the life expectancy figure of patients with sickle cell disease ( scd ) occurred around the middle of the 1970s ( fig . this minimal increase in life expectancy coincided with my appointment at thomas jefferson university as the associate director of the newly created adult sickle cell center . the num... | in the 1970s , sickle cell pain was treated with trial and error approach by increasing or decreasing the dose of an opioid or switching from one analgesic to another .
this approach was controversial with criticism and doubt about its usefulness . since then , advances in determining the structure of opioid receptor... |
type iii dysbetalipoproteinaemia is a kind of lipid metabolism disorders , caused by apo - e deficiency , which leads to accumulation of chylomicrons and very low density lipoprotein remnants in the plasma.123 lipid metabolism disorders are mostly manifested by xanthomas , which are known as yellowish cholesterol - ric... | familial dysbetalipoproteinaemia ( fdl ) is an inherited disorder in which both cholesterol and triglycerides are elevated in the plasma , pre - disposing the people to coronary artery disease and peripheral vascular disease .
the disease is mostly manifested by xanthomas , which have variable forms according to lipi... |
craniofacial defects are rare , disfiguring facial anomalies , with an incidence of about 1.4 to 4.9 cases per 100,000 live births . craniofacial clefts may be caused by failure of the maxillary processes to fuse , external pressure , amniotic bands , oligohydramnios , central disorganization of the neural crest , and ... | median cleft is the midline cleft of the lip .
it develops due to incomplete or failed fusion of the median nasal prominence .
it can present with minimal deformities such as involvement of the vermilion border , or complex clefting of the midline structures and brain .
median clefts are broadly classified as tru... |
spontaneous pneumothorax ( sp ) comprises the largest group and is classified into primary spontaneous ( psp ) and secondary spontaneous pneumothorax . psp usually occurs in young , tall , thin men , especially smokers , in the absence of an underlying lung disease . although , sp is a relatively common condition , bil... | bilateral primary spontaneous pneumothorax ( bpsp ) is a rare condition , accounting for 1.6% of spontaneous pneumothoraces .
patients with primary spontaneous pneumothorax have typically low body weight .
bpsp in overweight / obese patients is an exceptionally rare event .
the present report describes a case of ... |
the prevalence of syphilis in the normal population has decreased significantly since 1977 in korea ( 1 , 2 ) . however , in western countries the incidence of syphilis has risen , mainly in the 20 - 24 age group and its clinical manifestations have been various ( 3 ) . sexual activity has become more acceptable in our... | a 30-yr - old man was referred for suspicious rectal cancer because of ulcerated lesions in the rectum and a palpable mass in left inguinal area .
sigmoidoscopy showed two indurated masses and histologic evaluation of biopsy revealed obliterative endarteritis with heavy plasma cell infiltration . both venereal diseas... |
dysphagia is the subjective awareness of difficulty in the passage of solids or liquids from the oropharynx to the stomach . dysphagia can be classified into an oropharyngeal or an esophageal location , and it is caused by neuromuscular motility disorders and mechanical obstruction.1 ) mechanical dysphagia is associate... | dysphagia aortica is difficulty in swallowing caused by extrinsic compression of the esophagus due to an ectatic , tortuous , or aneurysmatic atherosclerotic thoracic aorta .
this condition is very uncommon , and it is usually associated with old age , women with short stature , hypertension , and kyphosis .
we rep... |
kcm is itself very rare and distinct type of keratoacanthoma which usually occurs over extremities and scalp is unusual site for development of lesion . treatment is difficult as lesion of kcm present with large raised , rolled borders with peripheral extension . keratoacanthoma ( ka ) is a rapidly evolving tumor , com... | keratoacanthoma ( ka ) is a rapidly evolving tumor , composed of keratinizing squamous cells originating in pilosebaceous follicles and resolving spontaneously if left untreated .
it is relatively uncommon in dark - skinned and occurs in middle aged individuals .
males are three times more affected than females .
... |
they are found most commonly in the cranial and peripheral nerves , and occurrence in the omentum is very rare . however , there have been some cases reported to develop serious complications and , if there was malignancy , to cause metastasis or recurrence . we presented a case of schwannoma originating from the great... | schwannoma in the abdomen is an uncommon neoplasm that occurs most frequently in the cranial and peripheral nerves ; it is extremely rare in the great omentum and only 6 cases of schwannoma of the great omentum have been observed previously .
we report the case of a schwannoma found in the great omentum of a 55-year ... |
sweet 's syndrome ( ss ) presenting in a localized and symmetric pattern is a very rare phenomenon . there have , however , been , a few case reports for the same . ss per se was first reported in 1964 by robert douglas sweet . though classically presenting as tender pseudovesicles , ss may demonstrate numerous topogra... | sweet 's syndrome is a well - known entity in the field of dermatology .
it has presented itself in myriad forms , well - recorded in literature .
our patient presented with a sudden eruption of nontender molluscoid pseudovesicles distributed over the neck and forearms alone . a complete diagnostic work up for the ... |
we used monthly reports of slide - confirmed malaria and annual census based population data from 434 counties ( municpios ) in the brazilian amazon region for 19961999 , during which no coordinated national malaria interventions occurred ( 12 ) . to study the relationship of reported malaria cases to climate , we use... | climate changes are altering patterns of temperature and precipitation , potentially affecting regions of malaria transmission .
we show that areas of the amazon basin with few wetlands show a variable relationship between precipitation and malaria , while areas with extensive wetlands show a negative relationship wi... |
the clavicle is a rare site for bone tumours . according to the world health organisation , the giant cell tumor is an aggressive potentially malignant lesion which means that its evolution based on histological features is unpredictable . sites commonly affected by giant cell tumour are proximal tibia , distal femur a... | highlightsgiant cell tumour of clavicle is a rare entity.the differntial diagnosis of giant cell tumour of clavicle which pose a diagnostic challenege gor both surgeon and histopathologist are aneurysmal bone cyst , non ossifying fibroma , tubercular osteomyelitis and eosniophilic granuloma.claviculecomy is a good opti... |
the pylorus , duodenal c - loop , and ileocecal valve are the three physiological narrowings in the gastrointestinal tract , and most of the swallowed indigestible foreign bodies pass through it without complications . however , foreign bodies such as a toothbrush can not pass out of the stomach , and the gastrointesti... | most of the ingested foreign bodies pass uneventfully through the gastrointestinal tract . however , long and rigid foreign bodies are associated with an increased risk of gastrointestinal impaction , perforation , and bleeding . spontaneous passage of a toothbrush has not been reported till date and the technique of i... |
para - aortic and pelvic lymphadenectomy is often performed in the treatment of ovarian or testicular cancer . internal herniation of a small bowel behind the external iliac artery after lymphadenectomy is a very rare complication to this procedure and to our knowledge only reported twice in the literature . in the fir... | introductioninternal herniation of a small bowel behind pelvic vessels is a rare complication seen after pelvic lymphadenectomy.presentation of casea 56-year - old woman was operated due to a gynecological cancer .
4 years thereafter she presented with a 2 days history of abdominal pain and vomiting .
clinical and ... |
fibro - osseous lesions of the jaws represent a diverse group of entities which include developmental ( hamartomatous ) lesions , reactive or dysplastic processes and neoplasms . benign fibro - osseous lesions of the head and neck region are uncommon and represent a wide range of tumors sharing some histopathological f... | juvenile ossifying fibroma ( jof ) is an uncommon , benign , bone - forming neoplasm with an aggressive local growth that is distinguished from other fibro - osseous lesions primarily by its age of onset , clinical presentation and aggressive behaviour .
jof is considered as a variant of the ossifying fibroma ( of ) ... |
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