Biomedical-TeMU/CodiEsp_corpus · Datasets at Hugging Face

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P53 29%.
Ki 67 35%.
Her-2 0%.
Keratin 56 positive 1/3.
EGFR negative.
Positive E-Caderin 3/3.
Androgen negative.
BCL2 positive 2/3.
It is a luminal B-Ki67 pattern with metastases in 1/19 lymph nodes.
In the immediate postoperative period she presented mild bleeding exteriorized by the drainage, being carried out conservative treatment.
On the seventh postoperative day, a 400 ml flow was observed through the axillary drainage, with the appearance of stenosis, suggestive of lymphorrhea.
Chylous fluid was confirmed by biochemical study (Triglycerides: 800 mg/dl, total cholesterol: 47 mg/dl).
A diet with restriction of fat is indicated, recommending the ingestion of foods with medium chain triglycerides and simultaneous subcutaneous somatostatin every 8 hours for 10 days.
With these measures, the quantity and aspect of axillary drainage improved and normalized, allowing its removal 20 days after surgery.
In subsequent controls, no other complications were observed, and the patient started to complete oncological treatment.
The patient is asymptomatic and disease free after 37 months of follow-up.
An 11-year-old male patient presented with a two-year history of left hip pain, which improved with rest.
Personal history included Arnold-Chiari, Dandy Walker associated hydrocephalia, treated with ventriculoperitoneal shunt and partial seizures.
Physical examination revealed gait dysfunction with an analgesic lameness and limb adduction and lumbar hyperlordosis.
The hip presented a flexion of 20o with a flexion range of 90o, external rotation of 20o, internal rotation 10o and consolidation 20o.
Blood count, acute phase inflammation markers and rheumatologic tests yielded normal results.
The plain radiograph showed discrete regional involvement ;.
TAC, edema and disorientation of the articular cartilage with synovial hypertrophy.
1.
An arthrocentesis under radioscopy control was performed under general anesthesia, but no synovial fluid sample was obtained.
The study was complemented with arthrography which confirmed the existence of severe chondrolysis.
With a presumptive diagnosis of idiopathic chondrolysis, rest, discharge of the limb with the use of guns and physical rehabilitation were prescribed.
One month later a hip fracture was treated with hyaluronic acid under radioscopic control.
The evolution was torpid with persistence of symptoms despite treatment.
Ten months after diagnosis, a soft joint mobilization under general anesthesia was performed, confirming the en bloc femoral head movement with the pelvis, which was assessed as fibrous ankylosis.
Due to joint stiffness, the option to perform periarticular tenotomy was ruled out.
From the year of diagnosis the articular rigidity improved slightly so that the treatment was complemented with traction of soft parts finding a favorable response in pain control and flexure attitude.
The patient used ambulatory traction for night periods, walking with English sticks and continued with rehabilitation treatment for 6 months.
After this treatment, the attitude of flexion disappeared, being able to perform a normal life without physical activity or prolonged walking, which caused episodes of pain and limping.
Four years later, a concentric loss of 50% of the articular space was observed, with erasure of the medial line and local dissection.
The clinical evolution was favorable with disappearance of the pain and spontaneous progressive recovery almost complete of the function and mobility in a period of 6 years, as well as partial recovery of the articular space.
MRI showed joint narrowing with subchondral lesions in the femoral head and acetabulum, with no sign changes in the medulla on both sides of the joint, with a destructive process of the carti.
MRI was not previously performed due to lack of availability in the center, but it would have been more appropriate to perform a differential diagnosis.
The range of joint motion at the end of the clinical follow-up was -10o for constipation, internal rotation and external rotation with an external rotation asymmetry of 1 cm in the affected limb.
Currently, after 14 years of follow-up since the onset of symptoms, the patient lives normally, asymptomatic, Trendelenburg (-), symmetrical and painless mobility of both hips (RI 30o, RE 65o).
A 46-year-old male with no history of interest presented in a routine work review recent onset iron deficiency anemia (Hb 11.3g/dL; MCV 79.8 μ3; Urea 29 mg/dL; Creatinine
The patient denied ingestion of gastro-injury drugs and digestive exteriorization of bleeding, so conventional endoscopic examination (gastroscopy and ileo-colonoscopy) was indicated, which was negative.
After 30 days, the study was completed with an ECE that was also negative. The study was concluded and symptomatic treatment with oral iron supplements was indicated.
At 3 months, the patient came to the emergency department for asthenia and melena in the last 48 hours.
Physical examination was pale and sweaty.
Her blood pressure was 90/60 mm Hg and her heart rate was 105 beats per minute. Her rectal examination revealed melanic stools.
The laboratory analysis of the service (Hb 7 g/dL; VCM 77.2 μ3; Urea 57 mg/dL; Creativity 7 mg/dL) confirmed the suspicion of digestive bleeding, emergency admission for observation.
In the first 24 hours 2,000 ml of fluid therapy were administered and 4 units of fluid replacement were administered. Post-fusion hemoglobin was 9.5 g/dL.
Once the patient was stabilized and when there was suspicion of upper gastrointestinal bleeding, an urgent gastroscopy was negative, repeating a new CES.
In this last exploration, the source of bleeding was identified from a gastric lesion of submucosal origin and ulcerated on its surface that was hidden between the gastric folds.
The definitive diagnosis was obtained after a new gastroscopy and after ruling out metastatic disease, resection was performed.
Histopathological study confirmed the submucosal origin of the lesion (gastric GIST).
A 49-year-old male smoker of 12 cigarettes a day and former drinker for 3 years.
She came to the emergency department due to progressive dyspnea on the previous days to minimal exertion, accompanied by edema, dizziness and syncope, with no accompanying chest pain or orthopnea.
A relevant history included infectious endocarditis in a myxoid mitral valve, with perforation and severe mitral regurgitation. The patient was initially treated with antibiotics and later replaced with mitral valve replacement with complicated mechanical valve replacement.
She was discharged 10 days before the current admission to treatment with acenocoumarol, bisoprolol, furosemide and amiodarone.
The physical examination revealed a regular general condition, hypotension (90 mmHg), jugular venous distension and hepatomegaly of 3 fingers.
The laboratory tests showed a significant increase in transaminase levels (AST: 5,550 U/L; ALT: 3,826 U/L) and LDH (10,375 U/L), with slightly elevated bilirubin levels (2 mg/dL).
He also had anemia (Hb: 9.2 g/dL), impaired renal function (Cr: 1.76 mg/dL; urea 88 mg/dL) and an I.N.R. of 9.86.
Serology for HAV, HBV, HCV, HIV, EBV, CMV and autoimmunity were negative.
The intake of drugs and other hepatotoxic products was discarded.
The electrocardiogram showed no changes of interest and ultrasound showed marked hepatomegaly with diffuse alteration of echogenicity in relation to steatosis, with normal hepatic vascular study.
suspecting a possible cardiac origin of the clinical picture, an echocardiogram was performed which confirmed the presence of massive pericardial effusion, predominantly in the right ventricular free wall, where it reached 60 mm thick, and in the left ventricle with 29 mm thick.
The right ventricle as well as the initial portion of the pulmonary artery appeared completely collapsed, data of severe echocardiographic taping.
1.
a The mild patient was referred to the Coronary Care Unit where diagnostic and evacuating pericardiocentesis was performed using an anterior approach (3o intercostal space for apical sequestration) located with 600 cc of hemorrhagic fluid collection.
Samples were sent for biochemistry, microbiology and cytology, confirming a leak with a hematocrit higher than plasma, being the microbiological study and cytology normal.
At the same time, corticosteroid treatment was initiated with good clinical response.
Analytically, normalization of creatinine levels (0.72 mg/dL) and progressive decrease in transaminase levels (568 U/L; ALT: 227 U/L) were observed.
Before discharge, a control echocardiogram showed mild pericardial effusion of fibrinous aspect, loculated, asymmetrical distribution, predominantly located anteriorly and apex of the right ventricle, with no data of hemodynamic compromise.
Because of the good clinical and analytical evolution, liver biopsy was not necessary and the patient was diagnosed with ischemic hepatitis due to low cost situation in relation to cardiac taping secondary to postpericardiotomy syndrome with hemorrhagic transformation.
Of note is a case of a complicated fracture and root, in which intraalveolar transplantation was used, using Lemix paste mixed with crown hydroxide during four years as intra-conduct medication, following its provisional evolution.
Case description:.
In 1996, a 13-year-old boy presented with a 1-week history of a fracture of the upper right central lobe without having received dental treatment.
On physical examination, a complicated fracture of the root-coronary reaches up to two millimeters below the gingival marginal edge was observed.
Surgical extrusion of the root was chosen.
After anesthesia with 4% mepivacaine, an incision was made in the periodontal ligament and the root was dislocated with a elevator placed on the mesiopalatal and palatal sides, respectively.
The root was extracted and additional fractures were located.
The apical fragment was replaced, seeking that the tooth was stabilized and the fracture was optimally exposed with minimal extrusion.
The tooth was rotated to a position of 90o from the original, which was considered more stable and subsequently ferulized to adjacent teeth.
To avoid interferences during occlusion, part of the crown was removed.
1.
One week after the initial treatment, the pulp was removed and filled with Ledermix and calcium hydroxide to equal parts, temporarily restoring the crown with composite.
After six months, in the absence of signs of root resorption, the canal was permanently filled with crown-percha, but it had suffered a discoloration, acquiring an intense gray color.
The bleaching technique of non-vital teeth was performed, using a mixture of glycerin and peroxidamide peroxide (Endoperox®, Septodont France).
The patient has been controlled for four years, not observing signs of root resorption in this period of time.
Patient with cleft lip and bilateral cleft palate.
The premaxilla was protruded and rotated to the right, and the lateral segments had collapsed.
This protrusion made lip surgery more difficult because it increased the tension of soft tissues.
1.
After taking the medication, an ECPR was designed and placed under general anesthesia.
Parents activated the device at home to achieve expansion and once a week we modified the tension of the cadets to achieve retrusion of the premaxilla.
1.
After six weeks the premaxilla had been retruded and the segments were aligned with what could be performed cheiloplasty using the Mken technique.
A 58-year-old man with a body surface area of 2.02 m presented with ischemic heart disease and chronic renal failure secondary to nephroangiocarcinoma.
When informed about dialysis techniques, PD was chosen when the patient wanted home treatment.
A self-locating catheter was implanted without incidents for PD using the surgical method.
A preoperative chest X-ray showed no pleural effusion or other remarkable changes.
1.
On March 30, 2004, continuous ambulatory PD (CAPD) was initiated with three daily exchanges of 2,000 cc to 1.36%.

P53 29%.

Ki 67 35%.

Her-2 0%.

Keratin 56 positive 1/3.

EGFR negative.

Positive E-Caderin 3/3.

Androgen negative.

BCL2 positive 2/3.

It is a luminal B-Ki67 pattern with metastases in 1/19 lymph nodes.

In the immediate postoperative period she presented mild bleeding exteriorized by the drainage, being carried out conservative treatment.

On the seventh postoperative day, a 400 ml flow was observed through the axillary drainage, with the appearance of stenosis, suggestive of lymphorrhea.

Chylous fluid was confirmed by biochemical study (Triglycerides: 800 mg/dl, total cholesterol: 47 mg/dl).

A diet with restriction of fat is indicated, recommending the ingestion of foods with medium chain triglycerides and simultaneous subcutaneous somatostatin every 8 hours for 10 days.

With these measures, the quantity and aspect of axillary drainage improved and normalized, allowing its removal 20 days after surgery.

In subsequent controls, no other complications were observed, and the patient started to complete oncological treatment.

The patient is asymptomatic and disease free after 37 months of follow-up.

An 11-year-old male patient presented with a two-year history of left hip pain, which improved with rest.

Personal history included Arnold-Chiari, Dandy Walker associated hydrocephalia, treated with ventriculoperitoneal shunt and partial seizures.

Physical examination revealed gait dysfunction with an analgesic lameness and limb adduction and lumbar hyperlordosis.

The hip presented a flexion of 20o with a flexion range of 90o, external rotation of 20o, internal rotation 10o and consolidation 20o.

Blood count, acute phase inflammation markers and rheumatologic tests yielded normal results.

The plain radiograph showed discrete regional involvement ;.

TAC, edema and disorientation of the articular cartilage with synovial hypertrophy.

1.

An arthrocentesis under radioscopy control was performed under general anesthesia, but no synovial fluid sample was obtained.

The study was complemented with arthrography which confirmed the existence of severe chondrolysis.

With a presumptive diagnosis of idiopathic chondrolysis, rest, discharge of the limb with the use of guns and physical rehabilitation were prescribed.

One month later a hip fracture was treated with hyaluronic acid under radioscopic control.

The evolution was torpid with persistence of symptoms despite treatment.

Ten months after diagnosis, a soft joint mobilization under general anesthesia was performed, confirming the en bloc femoral head movement with the pelvis, which was assessed as fibrous ankylosis.

Due to joint stiffness, the option to perform periarticular tenotomy was ruled out.

From the year of diagnosis the articular rigidity improved slightly so that the treatment was complemented with traction of soft parts finding a favorable response in pain control and flexure attitude.

The patient used ambulatory traction for night periods, walking with English sticks and continued with rehabilitation treatment for 6 months.

After this treatment, the attitude of flexion disappeared, being able to perform a normal life without physical activity or prolonged walking, which caused episodes of pain and limping.

Four years later, a concentric loss of 50% of the articular space was observed, with erasure of the medial line and local dissection.

The clinical evolution was favorable with disappearance of the pain and spontaneous progressive recovery almost complete of the function and mobility in a period of 6 years, as well as partial recovery of the articular space.

MRI showed joint narrowing with subchondral lesions in the femoral head and acetabulum, with no sign changes in the medulla on both sides of the joint, with a destructive process of the carti.

MRI was not previously performed due to lack of availability in the center, but it would have been more appropriate to perform a differential diagnosis.

The range of joint motion at the end of the clinical follow-up was -10o for constipation, internal rotation and external rotation with an external rotation asymmetry of 1 cm in the affected limb.

Currently, after 14 years of follow-up since the onset of symptoms, the patient lives normally, asymptomatic, Trendelenburg (-), symmetrical and painless mobility of both hips (RI 30o, RE 65o).

A 46-year-old male with no history of interest presented in a routine work review recent onset iron deficiency anemia (Hb 11.3g/dL; MCV 79.8 μ3; Urea 29 mg/dL; Creatinine

The patient denied ingestion of gastro-injury drugs and digestive exteriorization of bleeding, so conventional endoscopic examination (gastroscopy and ileo-colonoscopy) was indicated, which was negative.

After 30 days, the study was completed with an ECE that was also negative. The study was concluded and symptomatic treatment with oral iron supplements was indicated.

At 3 months, the patient came to the emergency department for asthenia and melena in the last 48 hours.

Physical examination was pale and sweaty.

Her blood pressure was 90/60 mm Hg and her heart rate was 105 beats per minute. Her rectal examination revealed melanic stools.

The laboratory analysis of the service (Hb 7 g/dL; VCM 77.2 μ3; Urea 57 mg/dL; Creativity 7 mg/dL) confirmed the suspicion of digestive bleeding, emergency admission for observation.

In the first 24 hours 2,000 ml of fluid therapy were administered and 4 units of fluid replacement were administered. Post-fusion hemoglobin was 9.5 g/dL.

Once the patient was stabilized and when there was suspicion of upper gastrointestinal bleeding, an urgent gastroscopy was negative, repeating a new CES.

In this last exploration, the source of bleeding was identified from a gastric lesion of submucosal origin and ulcerated on its surface that was hidden between the gastric folds.

The definitive diagnosis was obtained after a new gastroscopy and after ruling out metastatic disease, resection was performed.

Histopathological study confirmed the submucosal origin of the lesion (gastric GIST).

A 49-year-old male smoker of 12 cigarettes a day and former drinker for 3 years.

She came to the emergency department due to progressive dyspnea on the previous days to minimal exertion, accompanied by edema, dizziness and syncope, with no accompanying chest pain or orthopnea.

A relevant history included infectious endocarditis in a myxoid mitral valve, with perforation and severe mitral regurgitation. The patient was initially treated with antibiotics and later replaced with mitral valve replacement with complicated mechanical valve replacement.

She was discharged 10 days before the current admission to treatment with acenocoumarol, bisoprolol, furosemide and amiodarone.

The physical examination revealed a regular general condition, hypotension (90 mmHg), jugular venous distension and hepatomegaly of 3 fingers.

The laboratory tests showed a significant increase in transaminase levels (AST: 5,550 U/L; ALT: 3,826 U/L) and LDH (10,375 U/L), with slightly elevated bilirubin levels (2 mg/dL).

He also had anemia (Hb: 9.2 g/dL), impaired renal function (Cr: 1.76 mg/dL; urea 88 mg/dL) and an I.N.R. of 9.86.

Serology for HAV, HBV, HCV, HIV, EBV, CMV and autoimmunity were negative.

The intake of drugs and other hepatotoxic products was discarded.

The electrocardiogram showed no changes of interest and ultrasound showed marked hepatomegaly with diffuse alteration of echogenicity in relation to steatosis, with normal hepatic vascular study.

suspecting a possible cardiac origin of the clinical picture, an echocardiogram was performed which confirmed the presence of massive pericardial effusion, predominantly in the right ventricular free wall, where it reached 60 mm thick, and in the left ventricle with 29 mm thick.

The right ventricle as well as the initial portion of the pulmonary artery appeared completely collapsed, data of severe echocardiographic taping.

1.

a The mild patient was referred to the Coronary Care Unit where diagnostic and evacuating pericardiocentesis was performed using an anterior approach (3o intercostal space for apical sequestration) located with 600 cc of hemorrhagic fluid collection.

Samples were sent for biochemistry, microbiology and cytology, confirming a leak with a hematocrit higher than plasma, being the microbiological study and cytology normal.

At the same time, corticosteroid treatment was initiated with good clinical response.

Analytically, normalization of creatinine levels (0.72 mg/dL) and progressive decrease in transaminase levels (568 U/L; ALT: 227 U/L) were observed.

Before discharge, a control echocardiogram showed mild pericardial effusion of fibrinous aspect, loculated, asymmetrical distribution, predominantly located anteriorly and apex of the right ventricle, with no data of hemodynamic compromise.

Because of the good clinical and analytical evolution, liver biopsy was not necessary and the patient was diagnosed with ischemic hepatitis due to low cost situation in relation to cardiac taping secondary to postpericardiotomy syndrome with hemorrhagic transformation.

Of note is a case of a complicated fracture and root, in which intraalveolar transplantation was used, using Lemix paste mixed with crown hydroxide during four years as intra-conduct medication, following its provisional evolution.

Case description:.

In 1996, a 13-year-old boy presented with a 1-week history of a fracture of the upper right central lobe without having received dental treatment.

On physical examination, a complicated fracture of the root-coronary reaches up to two millimeters below the gingival marginal edge was observed.

Surgical extrusion of the root was chosen.

After anesthesia with 4% mepivacaine, an incision was made in the periodontal ligament and the root was dislocated with a elevator placed on the mesiopalatal and palatal sides, respectively.

The root was extracted and additional fractures were located.

The apical fragment was replaced, seeking that the tooth was stabilized and the fracture was optimally exposed with minimal extrusion.

The tooth was rotated to a position of 90o from the original, which was considered more stable and subsequently ferulized to adjacent teeth.

To avoid interferences during occlusion, part of the crown was removed.

1.

One week after the initial treatment, the pulp was removed and filled with Ledermix and calcium hydroxide to equal parts, temporarily restoring the crown with composite.

After six months, in the absence of signs of root resorption, the canal was permanently filled with crown-percha, but it had suffered a discoloration, acquiring an intense gray color.

The bleaching technique of non-vital teeth was performed, using a mixture of glycerin and peroxidamide peroxide (Endoperox®, Septodont France).

The patient has been controlled for four years, not observing signs of root resorption in this period of time.

Patient with cleft lip and bilateral cleft palate.

The premaxilla was protruded and rotated to the right, and the lateral segments had collapsed.

This protrusion made lip surgery more difficult because it increased the tension of soft tissues.

1.

After taking the medication, an ECPR was designed and placed under general anesthesia.

Parents activated the device at home to achieve expansion and once a week we modified the tension of the cadets to achieve retrusion of the premaxilla.

1.

After six weeks the premaxilla had been retruded and the segments were aligned with what could be performed cheiloplasty using the Mken technique.

A 58-year-old man with a body surface area of 2.02 m presented with ischemic heart disease and chronic renal failure secondary to nephroangiocarcinoma.

When informed about dialysis techniques, PD was chosen when the patient wanted home treatment.

A self-locating catheter was implanted without incidents for PD using the surgical method.

A preoperative chest X-ray showed no pleural effusion or other remarkable changes.

1.

On March 30, 2004, continuous ambulatory PD (CAPD) was initiated with three daily exchanges of 2,000 cc to 1.36%.