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EN100156
|
Exam: temperature
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100156
|
Exam: metacarpophalangeal
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100156
|
Exam: interphalagienne
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100156
|
Exam: interphalageal
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100156
|
Exam: gonadotropin
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100156
|
Exam: fetoprotein
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100156
|
Exam: were-pulse
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100156
|
Exam: BP
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100156
|
Exam: Sp02
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100156
|
Exam: SARS-CoV-2
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100156
|
Exam: CRP
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100156
|
Exam: LDH
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100156
|
Exam: weight
|
not available
| 9 |
A 38-year-old man presented with a seven month history of progressively worsening bilateral knees pain with associated swelling. The pain was present when the patient was at rest, and worsened when the legs was bearing weight, thus restricting his walking to short distances. His knees had become increasingly swollen. He was otherwise fit and well. His medical history was unremarkable and he was only taking a paracetamol, codeine and anti-inflammatory drugs for the pain.
Upon examination, the patient was seen to have visibly swollen popliteal fossa and marked quadriceps wasting of his right lower limb. On palpation, the masses was hard, mobile, well defined, and measured 0.5 - 04 cm. The swelling was non-tender and there were no associated skin changes. He could fully extend his knee, but flexion was restricted to only 110 degrees. There was a McMurray test proved equivocal and no ligamentous instability. An examination of the patient’s hip revealed no abnormality.
A plain radiograph of the patient’s knees revealed multiple calcific densities within the soft tissues surrounding it on the right one. Although some of these appeared to lie within the capsule, the majority appeared to be outside of it, and a solitary image on the left knee. These appearances were thought to be consistent with idiopathic tumoral calcinosis. However, to further scrutinize these calcifications, a magnetic resonance imaging (MRI) scan was recommended. It showed an extensive thickening of the patient’s synovium, multiple intraarticular calcific and ossific loose bodies, and large calcified bursal extensions. These findings were thought to be consistent with very extensive bilateral synovial chondromatosis. The patient’s blood tests were normal: C-reactive protein 5 mg/l and the phosphate calcium balance without errors.
A two-stage procedure was planned following the findings of the MRI scan. The first stage was arthroscopy, which was able to note Grade IV osteoarthritis alongside florid synovial chondromatosis in the lateral compartment of the right knee. There were multiple loose bodies within this compartment and nodules were fixed to the synovium. On the left one, we found an isolated synovial metaplasia in the subvastus quadriceps-sparing. A synovectomy with debridement and excision of these bodies was thus performed.
The second stage involved an open exploration of the patient’s popliteal fossa. Multiple calcified masses were found, all enclosed in bursal sacs. They were lateral to the semimembranosus at the level of the oblique popliteal ligament. All the masses were excised. A histological review confirmed our diagnosis of synovial chondromatosis. The sections showed nests of chondrocytes with focal ossification and focally attenuated synovium overlying the nodules. After the operation, the patient underwent functional rehabilitation sessions focusing on quadriceps strengthening, with a daily exercise regime to supplement this. He recovered well and ten weeks after the operation, has regained his right knee’s full range of movement with flexion increased to 130 degrees, which is equal to that of his left knee.
|
EN100184
|
Exam: haemoglobin
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: creatinine
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: sodium
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: potassium
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: proteinurea
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: FDP
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: ALP
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: INR
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: fibrinogen
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: pressure
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: temperature
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: metacarpophalangeal
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: interphalagienne
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: interphalageal
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: gonadotropin
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: fetoprotein
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: were-pulse
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: BP
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: Sp02
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: SARS-CoV-2
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: CRP
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: LDH
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100184
|
Exam: weight
|
not available
| 9 |
An eleven year old girl presented to the paediatric eye clinic of the University College Hospital, Ibadan, Nigeria with a history of squint and poor vision. Her mother had noticed a misalignment of the eyes three years previously and the patient had been complaining about poor distance vision for about a year. There was no history of antecedent trauma to the head or face. There was no history of double vision (diplopia) or pains on ocular movements. There was no associated headache, fever, vomiting, joint pains or skin rashes/lesions. The review of systems was essentially normal and she had enjoyed good health since early childhood. Her pregnancy and delivery were uneventful; and her development was normal. All other family members were well and there was no family history of squint. Unaided visual acuity was 6/24 in the right eye and counting fingers (CF) in the left eye. During refraction, her visual acuity improved to 6/9 and 6/60 in the right and left eyes respectively. The refractive error was a hypermetropia of +4.50 diopters in each eye. Examination revealed normal anterior and posterior segments bilaterally. There was about 10 prism diopters of left hypotropia with no horizontal deviation in the primary position and she did not have an abnormal head posture. Her palpebral fissures were normal and equal on both sides in the primary position of gaze. Examination of the ocular motility elicited marked limitation of elevation of the left eye when looking to the right, while elevation of the same eye was almost full on left gaze. The movements of the right eye were normal and there were no significant changes in the palpebral fissures of both eyes during eye movements. Forced duction test (performed under sedation) was positive and revealed marked restriction of passive elevation of the left eye in adduction. Her systemic examination was completely normal. A diagnosis of congenital left Brown syndrome with severe amblyopia was made. Spectacles were prescribed and she was commenced on a trial of amblyopia therapy which consisted of patching of the right eye for a period of 3-4 hours every day (after school). Her mother was counselled and educated about the condition as well as the treatment plan. Specifically, she was informed that surgery was necessary to correct the squint, irrespective of the outcome of the amblyopia therapy. A three month follow up visit was scheduled, however, the patient defaulted after the initial visit.
|
EN100466
|
Exam: haemoglobin
|
6.5g/dl.
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: creatinine
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: sodium
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: potassium
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: proteinurea
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: FDP
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: ALP
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: INR
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: fibrinogen
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: pressure
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: temperature
|
38.2 0 C.
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: metacarpophalangeal
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: interphalagienne
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: interphalageal
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: gonadotropin
|
0.258mIU/ml.
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: fetoprotein
|
7 ng/ml.
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: were-pulse
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: BP
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: Sp02
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: SARS-CoV-2
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: CRP
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: LDH
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100466
|
Exam: weight
|
not available
| 9 |
A 34-year-old recently diagnosed HIV positive para 4 was referred to us with a 2-month history of abdominal pain, abdominal distension and backache which had worsened 2 weeks prior to presentation. She also had pain on defecation, night sweats and fever. On examination she looked ill, in respiratory distress with a respiratory rate of 28 breaths per min. She was febrile with a temperature of 38.2 0 C and had unilateral leg swelling. The abdomen was asymmetrically distended with an abdominopelvic mass of about 30 weeks size. The mass was firm, immobile with an irregular surface not attached to overlying skin. There was no ascites and no hepatosplenomegaly. The cervix looked grossly normal but was displaced anteriorly. Digital rectal examination revealed a mass in the pouch of Douglas not involving the rectal mucosa. Examination of the other systems was normal. Investigations showed a haemoglobin of 6.5g/dl (NR 12-14g/dl), a slightly elevated cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7 ng/ml (NR < 10). Her CD4 count was 63cells/mm 3. Her renal and hepatic function tests were normal. An ultrasound scan showed a solid mass measuring 19.6cm x 12.5cm, posterior to the uterine fundus and extending to the left adnexa. The uterus and its endometrium were normal. Doppler ultrasound scan of the right lower limb showed no evidence of thrombosis and her chest X-ray showed perihilar lymphadenopathy. The patient was taken for surgical exploration and staging for ovarian malignancy. At laparotomy there was a left ovarian mass attached to a bulky uterus and sigmoid colon. The right ovary was enlarged to about 10cm diameter. The left fallopian tube and ovary could not be distinguished and separated from the tumour. The rest of the abdominal organs and omentum looked grossly normal. There was no ascites. Tumour was friable and was removed by blunt and sharp dissection. Total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. The general surgeons were present and they did a sigmoidectomy and a Hartmann's procedure. She had enlarged retroperitoneal lymph nodes which were not dissected to reduce intraoperative bleeding and postoperative morbidity. We had encountered significant bleeding from the friable tumor. Patient was sent to the high dependency unit where she recovered postoperatively. Histology of the specimens showed a large B cell lymphoma. A haematologist consulted and peripheral blood film and bone marrow aspirate were done. Both results were normal, ruling out abnormal cells in both samples. She was started on chemotherapy one month after surgery and by the time of writing she had received one cycle of cyclophosphamide, doxorubicin and vincristine. She has also been initiated on highly active antiretroviral therapy.
|
EN100700
|
Exam: haemoglobin
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN100700
|
Exam: creatinine
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN100700
|
Exam: sodium
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN100700
|
Exam: potassium
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN100700
|
Exam: proteinurea
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN100700
|
Exam: FDP
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
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EN100700
|
Exam: ALP
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
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EN100700
|
Exam: INR
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
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EN100700
|
Exam: fibrinogen
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
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EN100700
|
Exam: pressure
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
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EN100700
|
Exam: temperature
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
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EN100700
|
Exam: metacarpophalangeal
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
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EN100700
|
Exam: interphalagienne
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN100700
|
Exam: interphalageal
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
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EN100700
|
Exam: gonadotropin
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
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EN100700
|
Exam: fetoprotein
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
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EN100700
|
Exam: were-pulse
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN100700
|
Exam: BP
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN100700
|
Exam: Sp02
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN100700
|
Exam: SARS-CoV-2
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN100700
|
Exam: CRP
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN100700
|
Exam: LDH
|
not available
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN100700
|
Exam: weight
|
10kg.
| 9 |
A 17 months girl have been consulted in our service for colicky abdominal pain often associated with constipation and loss of appetite, since she was six months old. Parents kept her at home until they remarked visible peristalsis on the abdominal wall, which lead them to consult our service. She was born from a full-term and uncomplicated pregnancy during which the mother had no prenatal ultrasound (US). Her neonatal period was unremarkable. Clinical findings: on physical examination, she was colored and active. Her vitals were within normal limits as well as her anthropometric parameters (weight: 10kg). Her abdomen had moderate distension and peristaltic waves were visible on the abdominal wall. Abdomen was soft on palpation and tympanic on percussion. The digital rectal examination was unremarkable. Symptomatic treatment was initiated with lactulose (five mL bid) and an antispasmodic, trimebutine (five mL bid). Timeline: our patient experienced first symptoms since August 2019. Parents brought her at our service only on 27 th July 2020 two days after they remarked visible peristalsis on her abdominal wall. The patient has been treated and discharged in August 2020 and pathology results were available 11 days later. Diagnostic assessment: blood results were within normal range. Abdominal X-ray showed distension of an intestinal loop in the left lumbar region. Abdominal US identified a misleading colonic dilatation containing heterogeny echoic substance, with no other additional features. Contrast enema was unremarkable. Due to financial constraints, upper gastro-intestinal (GI) series and abdominal computed tomography (CT) could not be performed. An exploratory laparotomy has been indicated with presumptive diagnosis of intestinal duplication. Therapeutic intervention: after the median laparotomy, a dilatated segment of the jejunum was identified at approximately ten cm from the Treitz's angle. Its diameter was fourfold greater than of the adjacent bowel, to which the dilatation was connected abruptly, without any identified obstructive cause. It measured ten cm in length and had prominent serosal vessels. Adjacent mesentery was thickened. No further anatomic anomaly was identified. A resection of the dilatated portion was performed, followed by end-to-end jejunal anastomosis using Vicryl 3/0 in separate stitches. Follow-up and outcomes: microscopic examination revealed a lymphocytic infiltration of both layers of the muscularis propria. The dense lymphocytic infiltration was mainly constituted of T lymphocytes CD3+/8+ (C and D) and some B lymphocytes CD20+. Locally diminished actin coloration indicated atrophy of smooth muscle fibers. Nerve fibers and ganglion cells of myenteric and submucosal plexuses were intact with focalized absence of NK CD56+ cells around lymphocytic infiltration. No ectopic tissue was identified. The postoperative period was uneventful. The patient was on parenteral nutrition until day seven postoperatively. She was discharged on day ten and after three months of monthly follow-up, colicky abdominal pain and chronic constipation had disappeared since the early postoperative days. For the future, the follow-up will be done on a three months basis for a year and then, twice yearly.
|
EN104655
|
Exam: haemoglobin
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: creatinine
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: sodium
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: potassium
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: proteinurea
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: FDP
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: ALP
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: INR
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: fibrinogen
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: pressure
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: temperature
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: metacarpophalangeal
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: interphalagienne
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: interphalageal
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: gonadotropin
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: fetoprotein
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: were-pulse
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
EN104655
|
Exam: BP
|
not available
| 9 |
Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barré syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barré syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.
|
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