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EN100310
|
Exam: Her2neu
|
not available
| 7 |
We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter.
Computed tomography showed a thyroid nodule of the left lobe extended to the isthmus and the right lobe with anterior and posterior capsular rupture contracting close contact with the vascular axis left carotid-jugular plunging into the cervicothoracic away from the hole aortic arch.
There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue.
Immuno-histochemical staining of the slides with caldesmon, desmin, PanCK, CK5-6, CK7, myogenin, epithelial membrane antigen (EMA), CEA, thyroid transcription factor (TTF-1), pancytokeratin, smooth muscle actin (SMA), MelanA, S 100 protein, CD 45, CD3, CD30, CD 20, CD 15, CD34, ALK, calcitonin and KI 67 protein was performed. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3.
In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
|
EN100310
|
Exam: ER
|
not available
| 7 |
We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter.
Computed tomography showed a thyroid nodule of the left lobe extended to the isthmus and the right lobe with anterior and posterior capsular rupture contracting close contact with the vascular axis left carotid-jugular plunging into the cervicothoracic away from the hole aortic arch.
There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue.
Immuno-histochemical staining of the slides with caldesmon, desmin, PanCK, CK5-6, CK7, myogenin, epithelial membrane antigen (EMA), CEA, thyroid transcription factor (TTF-1), pancytokeratin, smooth muscle actin (SMA), MelanA, S 100 protein, CD 45, CD3, CD30, CD 20, CD 15, CD34, ALK, calcitonin and KI 67 protein was performed. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3.
In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
|
EN100310
|
Exam: PR
|
not available
| 7 |
We present a case of a 32-year-old woman with a history of gradual enlargement of the anterior neck. The medical history was unremarkable and no comorbidities existed. There was no history of radiation exposure. Clinical examination revealed a multinodular goiter.
Computed tomography showed a thyroid nodule of the left lobe extended to the isthmus and the right lobe with anterior and posterior capsular rupture contracting close contact with the vascular axis left carotid-jugular plunging into the cervicothoracic away from the hole aortic arch.
There was no evidence of lung lesions. The patient underwent a surgical exploration. There was a hard left lobe nodule of 5 cm infiltrating the adjacent muscles and partially infiltrates the trachea. The intraoperative consultation pathology diagnosis was: undifferentiated carcinoma. A total thyroidectomy was realized. Histological examination showed a proliferation of elongated spindle-shaped cells, arranged in interweaving fascicles of varying sizes, intersected at right angles. Tumor cells are atypical with strange nuclei. Chromatin is distributed inhomogeneously. The cytoplasmic membrane is irregular and thick. The nucleolus is very large. The tumor realize a pushing against thyroid parenchyma which is separated with a fibrous capsule. The mitotic rate was extremely high (19 mitosis/10 high power field), and atypical mitotic figures were also present. The neoplasia showed invasion of the peri-glandular fat tissue.
Immuno-histochemical staining of the slides with caldesmon, desmin, PanCK, CK5-6, CK7, myogenin, epithelial membrane antigen (EMA), CEA, thyroid transcription factor (TTF-1), pancytokeratin, smooth muscle actin (SMA), MelanA, S 100 protein, CD 45, CD3, CD30, CD 20, CD 15, CD34, ALK, calcitonin and KI 67 protein was performed. The tumour was strongly positive for caldesmon, SMA, desmin, and negative for pancytokeratin and other epithelial, lymphoid and melanocytic markers. On the basis of the clinical, radiographic, histopathological and immunohistochemical features, the final diagnosis was primary thyroid leiomyosarcoma, FNCLCC grade 3.
In multidisciplinary tumour board, it was decided that adjuvant loco regional RT and chemotherapy by ifosfamide and doxorubicin.
|
EN100399
|
Exam: radiogram
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: electrocardiogram
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: phosphokinase
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: troponin
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: lymphopenia
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: globulin
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: nitrogen
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: cholesterol
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
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EN100399
|
Exam: Echocardiogram
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
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EN100399
|
Exam: hemoglobin
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
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EN100399
|
Exam: amylase
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
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EN100399
|
Exam: lipase
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
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EN100399
|
Exam: cytokeratin
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: CK7
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: synaptophysin
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: CD56
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: SCAN
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: fever
|
40°C.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: WBC
|
20.830.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: aminotransferase
|
56 IU/L.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: ALT
|
56 IU/L.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: LDH
|
255 IU/L.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: phosphatase
|
normal.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: Entamoeba
|
negative.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: echinococcus
|
negative.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: leismania
|
negative.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: brucella
|
negative.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: amikacin
|
≤0.125.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: cefepime
|
≤0.5.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: ciprofloxacin
|
≤0.125.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: gentamycin
|
≤0.5.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: meropenem
|
≤0.032.
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: chromogranin
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: Synaptophysin
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: CD10
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
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EN100399
|
Exam: Ki-67
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: pressure
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: HIV
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: HCV
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: HB
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: Platelets
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: INR
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: AFP
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: Her2neu
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: ER
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100399
|
Exam: PR
|
not available
| 7 |
A 23-year-old previously healthy man, presented to the hospital's emergency department, with a 3-day history of high-grade fever up to 40°C and upper right abdominal pain. The patient's past medical history was non-significant. He was a student and had not received any medication. He had a pet dog and reported no recent travel. During physical examination on admission, vital signs were normal and he was febrile with a body temperature of 38°C. Abdominal examination revealed a tender palpable liver, with no signs of peritoneal irritation. The remainder of physical examination was unremarkable. Abnormal laboratory results on admission included a white blood cell count (WBC) of 20.830 (4-10.5x10³/μL), elevated C-reactive protein (CRP) level (28mg/dl, normal ≤0.5mg/dl), slightly elevated alanine aminotransferase (ALT) of 56 IU/L (normal 5-40 IU/L), and lactic dehydrogenase (LDH) of 255 IU/L (normal <225 IU/L). Alkaline phosphatase (ALP) was normal. Abdominal ultrasonography on admission revealed a mildly enlarged liver and spleen and the presence of 2 sizable, hypoechoic lesions. Abdominal computed tomography (CT) scan revealed the 2 aforementioned lesions in diameter of 5.6cm at the left liver lobe and 5.2cm in the right lobe. The lesions were hypodense and presented peripheral enhancement after intravenous contrast, similar to the morphology of hepatic abscesses. The patient was admitted for further evaluation and treatment. Culture guided antimicrobials and appropriate drainage was our first option. Empiric antibiotic therapy with intravenous ciprofloxacin (400mg every 12 hours), and metronidazole (500mg every 8 hours) was initiated. All cultures resulted negative. Initially, we performed percutaneous sonographic (U/S) guided aspiration into the left hepatic abscess cavity. A thick, purulent material of 40cc was drained and sent for culture. Microbiology revealed a Gram-negative bacterium that presented slow growth. On the 5th and 8th days of admission, we performed CT guided catheter drainage of both abscesses. Meanwhile irregular spikes of fever with daytime variation accompanied by night sweats persisted. Ciprofloxacin discontinued and meropenem at a dose of 1gr every 8 hours administered. Thorough screening for other possible sources of infection, resulted negative. Transthoracic echocardiography was negative for vegetations and showed mild mitral regurgitation. Entamoeba histolytica Abs, echinococcus Abs, leismania Abs, brucella Abs were negative. Gastrointestinal endoscopic evaluation was unrevealing. The patient was also HIV negative and no other immunodeficiency conditions were identified. Eventually, the isolate identified by the Vitek 2 automated system and classified as A. aphrophilus. To confirm the identification of the strain we performed matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). The sensitivity test was performed with minimal inhibitory concentration (MIC) test strips; the isolate's susceptibility was to ceftriaxone ≤0.125 (S), cefepime ≤0.5 (S), ciprofloxacin ≤0.125 (S), gentamycin ≤0.5 (S), amikacin ≤0.125 (S) and to meropenem ≤0.032 (S). Percutaneous drainage of both abscesses, combined with antimicrobial treatment, was successful and the patient's clinical condition improved. Thankfully, no surgical procedure was required. The drains were removed immediately the fluid from the abscess cavities became clear. Meropenem was administered for a total of 2 weeks. Then meropenem was switched to oral ciprofloxacin for another 4 weeks and the patient was discharged from the hospital, in full recovery. Follow-up sonogram obtained almost 2 months after the drainage showed completely normal liver parenchyma without any residual liver cavities.
|
EN100415
|
Exam: radiogram
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: electrocardiogram
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: phosphokinase
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: troponin
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: lymphopenia
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: globulin
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: nitrogen
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: cholesterol
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: Echocardiogram
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: hemoglobin
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: amylase
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: lipase
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: cytokeratin
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: CK7
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: synaptophysin
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: CD56
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: SCAN
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: fever
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: WBC
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: aminotransferase
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: ALT
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: LDH
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: phosphatase
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: Entamoeba
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: echinococcus
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: leismania
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: brucella
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: amikacin
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: cefepime
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: ciprofloxacin
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: gentamycin
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: meropenem
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: chromogranin
|
positive.
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: Synaptophysin
|
strongly positive.
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: CD10
|
negative.
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: Ki-67
|
less than 2% positive.
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: pressure
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: HIV
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: HCV
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: HB
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: Platelets
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: INR
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: AFP
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: Her2neu
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: ER
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100415
|
Exam: PR
|
not available
| 7 |
A 57 year old lady presented to a peripheral hospital with complaints of penetrating epigastric pain of a week’s duration. There was no vomiting or weight loss. Bowel movements were normal. Clinical examination at the time was unrevealing. An abdominal ultrasound examination was reported as normal. The patient’s insistence on full investigation of the persistent epigastric pain led to a computed tomographic examination and discovery of a pancreatic tumour subsequent to which she was referred to our institution.
The CT scan showed a large tumour (6cm in largest diameter) in the body and tail of pancreas with no evidence of metastasis. She was prepared for exploratory laparotomy. The pancreas was explored through the gastrocolic omentum. The body and tail of the pancreas including the tumour were resected. The spleen was also removed. The end of the pancreas was suture ligated. Her post-operative recovery was uneventful. Histological examination of the specimen showed a well circumscribed ovoid tumour 60mm x 50mm across. Sections revealed islands and trabeculae of regular cells with variable amounts of eosinophilic cytoplasm, mostly regular nuclei with indistinct nucleoli. Areas of necrosis were present with hemorrhage. A fibrous pseudo-capsule was noted around the tumour and the resection of the tumour appeared complete. No capsular of vascular invasion was seen. Immuno-peroxidase staining was positive for chromogranin A. Synaptophysin was strongly positive, CD10 was negative, Ki-67 was less than 2% positive and the mitotic count was between 2-20 per 10 hpf. The staining reactions were confirmatory of a neuroendocrine carcinoma of the pancreas. The final staging of the completely excised tumour was T3 N0 M0.
Following discharge, she was followed up regularly and remains symptom free. A CT Scan performed 2 years after surgery showed no evidence of tumour recurrence.
|
EN100497
|
Exam: radiogram
|
not available
| 7 |
A 26 years old nulliparous woman presented to our observation for severe right-sided epistaxis, non self-limiting. She had few episodes in the previous two weeks of epistaxis, even 3-4 per day, usually stopping spontaneously. She reported a negative ENT consultation except for mild hyperemia of nasal mucosa. The pregnancy was unremarkable, considered at low risk, at 39.6 weeks of gestation. Her familiar and personal history was negative for blood coagulopathies and hypertension. We tried to stop severe epistaxis with nasal packing and intravenous tranexamic acid. On the basis of the failure of our procedures an otolaryngologist performed an endoscopy identifying bleeding enlarged vessels. Nasal packing with hemostatic sponge was successful, the pregnant woman was admitted to ob&gyn department. Her hemoglobin levels dropped down to 6 mg/dl and she needed 4 red cell packs. The day after her right nostril despite the tampons started bleeding again. She was referred to otolaryngologist who packed again the nose, bilaterally and used hemostatic glue. After 2 more days she started bleeding again, her nose was again packed with glue and tampons and further 2 red cell packs were given. The obstetric scan revealed biometry at 40 th centile, the Bishop score was 5, so we decided to induce labour after obtaining her informed written consent. The labour induction was performed with intravaginal prostaglandins (10 mg dinoprostone). After 18 hours the labour seemed to proceed well with cervical dilatation of 6 cm, level of head 0, but the cardiotocography (CTG) trace revealed anomalies that after 1 hour induced the shift versus cesarean section. No epistaxis happened during labour nor during cesarean section. Two days after nasal tampons were removed, the patient was discharged the day after. One month later the woman reported general good health and no epistaxis episodes, nor mild nor massive.
|
EN100497
|
Exam: electrocardiogram
|
not available
| 7 |
A 26 years old nulliparous woman presented to our observation for severe right-sided epistaxis, non self-limiting. She had few episodes in the previous two weeks of epistaxis, even 3-4 per day, usually stopping spontaneously. She reported a negative ENT consultation except for mild hyperemia of nasal mucosa. The pregnancy was unremarkable, considered at low risk, at 39.6 weeks of gestation. Her familiar and personal history was negative for blood coagulopathies and hypertension. We tried to stop severe epistaxis with nasal packing and intravenous tranexamic acid. On the basis of the failure of our procedures an otolaryngologist performed an endoscopy identifying bleeding enlarged vessels. Nasal packing with hemostatic sponge was successful, the pregnant woman was admitted to ob&gyn department. Her hemoglobin levels dropped down to 6 mg/dl and she needed 4 red cell packs. The day after her right nostril despite the tampons started bleeding again. She was referred to otolaryngologist who packed again the nose, bilaterally and used hemostatic glue. After 2 more days she started bleeding again, her nose was again packed with glue and tampons and further 2 red cell packs were given. The obstetric scan revealed biometry at 40 th centile, the Bishop score was 5, so we decided to induce labour after obtaining her informed written consent. The labour induction was performed with intravaginal prostaglandins (10 mg dinoprostone). After 18 hours the labour seemed to proceed well with cervical dilatation of 6 cm, level of head 0, but the cardiotocography (CTG) trace revealed anomalies that after 1 hour induced the shift versus cesarean section. No epistaxis happened during labour nor during cesarean section. Two days after nasal tampons were removed, the patient was discharged the day after. One month later the woman reported general good health and no epistaxis episodes, nor mild nor massive.
|
EN100497
|
Exam: phosphokinase
|
not available
| 7 |
A 26 years old nulliparous woman presented to our observation for severe right-sided epistaxis, non self-limiting. She had few episodes in the previous two weeks of epistaxis, even 3-4 per day, usually stopping spontaneously. She reported a negative ENT consultation except for mild hyperemia of nasal mucosa. The pregnancy was unremarkable, considered at low risk, at 39.6 weeks of gestation. Her familiar and personal history was negative for blood coagulopathies and hypertension. We tried to stop severe epistaxis with nasal packing and intravenous tranexamic acid. On the basis of the failure of our procedures an otolaryngologist performed an endoscopy identifying bleeding enlarged vessels. Nasal packing with hemostatic sponge was successful, the pregnant woman was admitted to ob&gyn department. Her hemoglobin levels dropped down to 6 mg/dl and she needed 4 red cell packs. The day after her right nostril despite the tampons started bleeding again. She was referred to otolaryngologist who packed again the nose, bilaterally and used hemostatic glue. After 2 more days she started bleeding again, her nose was again packed with glue and tampons and further 2 red cell packs were given. The obstetric scan revealed biometry at 40 th centile, the Bishop score was 5, so we decided to induce labour after obtaining her informed written consent. The labour induction was performed with intravaginal prostaglandins (10 mg dinoprostone). After 18 hours the labour seemed to proceed well with cervical dilatation of 6 cm, level of head 0, but the cardiotocography (CTG) trace revealed anomalies that after 1 hour induced the shift versus cesarean section. No epistaxis happened during labour nor during cesarean section. Two days after nasal tampons were removed, the patient was discharged the day after. One month later the woman reported general good health and no epistaxis episodes, nor mild nor massive.
|
EN100497
|
Exam: troponin
|
not available
| 7 |
A 26 years old nulliparous woman presented to our observation for severe right-sided epistaxis, non self-limiting. She had few episodes in the previous two weeks of epistaxis, even 3-4 per day, usually stopping spontaneously. She reported a negative ENT consultation except for mild hyperemia of nasal mucosa. The pregnancy was unremarkable, considered at low risk, at 39.6 weeks of gestation. Her familiar and personal history was negative for blood coagulopathies and hypertension. We tried to stop severe epistaxis with nasal packing and intravenous tranexamic acid. On the basis of the failure of our procedures an otolaryngologist performed an endoscopy identifying bleeding enlarged vessels. Nasal packing with hemostatic sponge was successful, the pregnant woman was admitted to ob&gyn department. Her hemoglobin levels dropped down to 6 mg/dl and she needed 4 red cell packs. The day after her right nostril despite the tampons started bleeding again. She was referred to otolaryngologist who packed again the nose, bilaterally and used hemostatic glue. After 2 more days she started bleeding again, her nose was again packed with glue and tampons and further 2 red cell packs were given. The obstetric scan revealed biometry at 40 th centile, the Bishop score was 5, so we decided to induce labour after obtaining her informed written consent. The labour induction was performed with intravaginal prostaglandins (10 mg dinoprostone). After 18 hours the labour seemed to proceed well with cervical dilatation of 6 cm, level of head 0, but the cardiotocography (CTG) trace revealed anomalies that after 1 hour induced the shift versus cesarean section. No epistaxis happened during labour nor during cesarean section. Two days after nasal tampons were removed, the patient was discharged the day after. One month later the woman reported general good health and no epistaxis episodes, nor mild nor massive.
|
EN100497
|
Exam: lymphopenia
|
not available
| 7 |
A 26 years old nulliparous woman presented to our observation for severe right-sided epistaxis, non self-limiting. She had few episodes in the previous two weeks of epistaxis, even 3-4 per day, usually stopping spontaneously. She reported a negative ENT consultation except for mild hyperemia of nasal mucosa. The pregnancy was unremarkable, considered at low risk, at 39.6 weeks of gestation. Her familiar and personal history was negative for blood coagulopathies and hypertension. We tried to stop severe epistaxis with nasal packing and intravenous tranexamic acid. On the basis of the failure of our procedures an otolaryngologist performed an endoscopy identifying bleeding enlarged vessels. Nasal packing with hemostatic sponge was successful, the pregnant woman was admitted to ob&gyn department. Her hemoglobin levels dropped down to 6 mg/dl and she needed 4 red cell packs. The day after her right nostril despite the tampons started bleeding again. She was referred to otolaryngologist who packed again the nose, bilaterally and used hemostatic glue. After 2 more days she started bleeding again, her nose was again packed with glue and tampons and further 2 red cell packs were given. The obstetric scan revealed biometry at 40 th centile, the Bishop score was 5, so we decided to induce labour after obtaining her informed written consent. The labour induction was performed with intravaginal prostaglandins (10 mg dinoprostone). After 18 hours the labour seemed to proceed well with cervical dilatation of 6 cm, level of head 0, but the cardiotocography (CTG) trace revealed anomalies that after 1 hour induced the shift versus cesarean section. No epistaxis happened during labour nor during cesarean section. Two days after nasal tampons were removed, the patient was discharged the day after. One month later the woman reported general good health and no epistaxis episodes, nor mild nor massive.
|
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