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PMC11324202_01_cro-2024-0017-0001-539776_F03.jpg
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a October 2022 PET/CT scan showing FDG activity of the distal body lesion. b Repeat PET/CT June 2023 PET/CT scan showing activity of the pancreatic body lesion. The interim PET/CT scan showed no change.
An initial PET scan performed in October 2022 demonstrated intense FDG activity in the distal body of the pancreas (Fig. 3a). PET showed normal uptake throughout the pancreas without evidence of metastatic disease in the chest, abdomen, or pelvis (Fig. 3b).
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Purpuric lesions over the face.
After chest drain and aspiration of chylous fluid, at 12 h of age, the neonate acutely developed well-demarcated erythematous macules that progressed rapidly to develop irregular central areas of blue-black purpuric lesions over the face, abdomen, and arms (Figures 1, 2).
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Purpuric lesions over the abdomen and the arm.
After chest drain and aspiration of chylous fluid, at 12 h of age, the neonate acutely developed well-demarcated erythematous macules that progressed rapidly to develop irregular central areas of blue-black purpuric lesions over the face, abdomen, and arms (Figures 1, 2).
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Case 4. (A) Preoperative. (B) Longitudinal and elliptical incisions. (C-E) Dissection of the aneurysmal vein from the vessel bed. (F) After removal of thrombi and fibrotic tissue from the vein. (G) After removal of the redundant vessel wall. (H) Aneurysmorrhaphy with calibration to a 28 Fr chest tube. (I) After removal of clamps and establishment of haemostasis. (J) Simple interrupted suture of the skin (patient's tattoos have been slightly blurred in images to protect their privacy).
After removal of the thrombi and the previously placed stent entrapped in atheromatous plaques, the venous wall was recalibrated and the reconstructed vein was shortened to lie appropriately in the vessel bed (Fig. 1).
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Case 5. (A) Preoperative. (B) Dissection of the aneurysmal vein. (C) Aneurysmorrhaphy with calibration to a 28 Fr chest tube. (D) Simple interrupted suture of the skin. (E) Two weeks post-operative.
AVF placement five years ago, and presented to the clinic with a severely tortuous aneurysm of the cephalic vein, which had resulted in multiple bleedings from wounds on the stretched skin. After aneurysmorrhaphy of the cephalic vein, part of the vessel was resected and re-anastomosed to achieve a desirable venous length (Fig. 2).
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Case 4. (A) Preoperative. (B) Longitudinal and elliptical incisions. (C-E) Dissection of the aneurysmal vein from the vessel bed. (F) After removal of thrombi and fibrotic tissue from the vein. (G) After removal of the redundant vessel wall. (H) Aneurysmorrhaphy with calibration to a 28 Fr chest tube. (I) After removal of clamps and establishment of haemostasis. (J) Simple interrupted suture of the skin (patient's tattoos have been slightly blurred in images to protect their privacy).
After removal of the thrombi and the previously placed stent entrapped in atheromatous plaques, the venous wall was recalibrated and the reconstructed vein was shortened to lie appropriately in the vessel bed (Fig. 1).
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Case 5. (A) Preoperative. (B) Dissection of the aneurysmal vein. (C) Aneurysmorrhaphy with calibration to a 28 Fr chest tube. (D) Simple interrupted suture of the skin. (E) Two weeks post-operative.
AVF placement five years ago, and presented to the clinic with a severely tortuous aneurysm of the cephalic vein, which had resulted in multiple bleedings from wounds on the stretched skin. After aneurysmorrhaphy of the cephalic vein, part of the vessel was resected and re-anastomosed to achieve a desirable venous length (Fig. 2).
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Timeline of the diagnostics, therapeutic interventions, and disease status of the present case. CEZ, cephazolin; CMR, cardiac magnetic resonance; CT, computed tomography; CXR, chest radiograph; COVID-19, coronavirus disease; Dx, diagnosis; ECG, electrocardiogram; FDG/PET, glucose analog 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography; iv, intravenous; JVD, jugular vein distention; MMSE, methicillin-sensitive Staphylococcus aureus; MRI, magnetic resonance imaging; NPS, nasopharyngeal swab; P/E, physical examination; PF, pericardial fluid; RT-PCR, reverse-transcriptase polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SBT/ABPC, ampicillin-sulbactam; TTE, transthoracic echocardiography; VATS-biopsy, video-assisted thoracoscopic biopsy.
We present a summarized illustration of the case presentation in Figure 5.
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The patient's CT scans at baseline, at best response, and at the last evaluation. (A-C) Evolution of a left supraventricular node. (D-F) Retroperitoneal node. The images in (A) and (D) were taken before starting immunotherapy treatment, while the images in (B) and (E) are those at the best response (this patient experienced a partial response with a -76% reduction in the target lesions). The images in (C) and (F) are the last scans of the patient in January 2024, when the decision to stop the treatment was made after 34 months. The red lines denote measurable disease.
Based on the MSI-H result, the patient was enrolled in a basket clinical trial, in which he underwent treatment for 34 months with second-line atezolizumab with partial response (-76%) and complete metabolic response with excellent treatment tolerance ( Figure 1 ).
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Shows inferonasal iris coloboma in the right eye of the patient.
The pupil in the right eye was pear-shaped with a notch at the inferonasal location (Figure 1).
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Shows lateral temporal iris coloboma in the left eye of the patient.
The pupil in the left eye was pear-shaped with a notch toward the left canthus (Figure 2).
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Preoperative extraoral portrait view
A male patient, age 75, arrived at the prosthodontics department with chief complaints of worn-down teeth, difficulty chewing, and aesthetic concerns (Figure 1).
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Preoperative photograph showing generalized attrition and restored cervical attrition
The patient had a reduced VDO and generalized attrition affecting all of the teeth, according to a clinical examination, along with generalized cervical abrasion, which was restored by composite resin (Figure 2).
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Panoramic radiograph showing the requirement of root canal treatment
A radiograph examination revealed the requirement of root canal treatment for 12, 13, 15, 22, 24, 25, 31, 32, 33, 34, 35, 41, 42, 43, and 46 (Figure 3).
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Facebow record
The Hanau spring bow recorded the orientation jaw relation, and Dawson's technique captured the centric relation (CR) (Figure 4).
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Provisional crowns in situ
Temporary luting cement, Prime, Maharashtra, India) the provisional fixed restorations were scrutinized for aesthetics and phonetics (Figure 5). The adaptation of these provisional restorations was assessed over four weeks.
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Master impression: (A) Maxillary Arch and (B) mandibular arch
Following this period, an impression of the entire arch was obtained using elastomeric impression material (GC Flexceed; GC India, Telangana, India) (Figure 6A, 6B).
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Vertical and centric record transfer: (A) Left side, (B) right side, and (C) front side
The right and anterior segments underwent a similar process (Figures 7A-7C).
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Metal copings try in
Subsequent to making wax patterns, metal copings were fabricated and evaluated in the patient's mouth to ensure a proper fit, which was subsequently confirmed by the working cast (Figure 8).
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Final prostheses in situ
Finally, the PFM crowns were cemented, and subsequent occlusal adjustments were performed to ensure adequate contact and functionality (Figure 9).
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Smile of satisfaction
The patient expressed satisfaction with the outcome, noting fulfilment in both the aesthetics and function of the teeth, which, in turn, restored his confidence and dignity (Figure 10).
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A graph depicting motor power of extremities in relation to serum magnesium level.
Furthermore, bilateral deep tendon reflexes (knee, ankle, biceps, and triceps) were absent, plantar reflexes were up going, and the muscle strength was 3/5 in both lower extremities and 4+/5 in both upper extremities (Figure 1).
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A graph depicting the serum magnesium level over the post-partum days.
Subsequently, the serum magnesium level was determined, and the patient was found to have severe hypermagnesemia, with a peak serum magnesium level of 6.4 mg/dl (normal laboratory level of serum magnesium: 1.7-2.2mg/dL) (Figure 2).
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Total colonoscopy images. (A-D) First procedure performed on January 9, 2022, showing mucosal redness, edema, granular change, and multiple small mucosal ulceration. (E-H) Second procedure performed on January 28, 2022, showing multiple deep oval ulcers (arrows).
Following comprehensive history-taking, physical examination, and blood tests, he underwent colonoscopy, which revealed mucosal erythema, edema, granular changes, and multiple small mucosal ulcerations, and he was diagnosed with UC (Figures 1A-D). Repeat colonoscopy performed to further evaluate intestinal mucosal inflammation revealed several round, large, and oval deep ulcers throughout the colon (Figures 1E-H).
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Abdominal CT scan findings. Image showing diffuse thickening of the colonic wall of ascending and descending colon (A) and sigmoid colon (B) (arrows), likely secondary to inflammation.
Abdominal computed tomography (CT) revealed a thickened colonic wall with pericolonic exudates (Figure 2).
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Chest X-ray, CT and MRI findings. (A) Nodular shadow in the left lower lung field detected on chest X-ray. Orange arrow indicates the area of abnormal chest shadow. (B) Anterior mediastinal tumor with poor contrast effect detected on CT (size: 6.0 cm x 3.1 cm x 1.9 cm). The tumor grew from 2.2 to 6.0 cm within 21 months. Orange arrow indicates anterior mediastinal tumor. (C) Anterior mediastinal tumor detected on T2-weighted MRI. Chest MRI revealed that the main component of the tumor was liquid. Orange arrow indicates anterior mediastinal tumor. CT, computed tomography; MRI, magnetic resonance imaging.
A 75-year-old woman presented to our hospital with an abnormal chest shadow, which was identified during a medical examination (Figure 1A). Chest computed tomography (CT) revealed an inflammatory nodule in the lingula and an anterior mediastinal mass with a poor contrast effect measuring 6.0 cm x 3.1 cm x 1.9 cm (Figure 1B), which grew from 2.2 to 6.0 cm over 21 months. Low and high signals were detected on T1- and T2-weighted thoracic magnetic resonance imaging, respectively (Figure 1C). By POD 9, partially improving the subglottic stenosis (Figure 3C), thereafter the subglottic stenosis was almost completely alleviated by POD 12 (Figure 3D) (Figure S1A,S1B) and gradual improvement continued (Figure S1C). Hydrocortisone was discontinued on POD 14, and the tracheal cannula was removed on POD 22 (Figure S1D,S1E). Trachea-cutaneous fistula closure was performed on POD 35, and she was discharged on POD 42, remaining well (Figure S1F-S1H).
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Laryngoscopic findings. (A) On POD 1, laryngoscopy revealed submucosal hemorrhage around the vocal cords and mild subglottic stenosis. None of the findings prompted emergency treatment. (B) On POD 4, laryngoscopy revealed progressive subglottic stenosis. POD, postoperative day.
L/min oxygen flow rate. Laryngoscopy showed submucosal hemorrhage around the vocal cords and mild subglottic stenosis just below the glottis; however, there was no arytenoid dislocation or findings necessitating emergency treatment (Figure 2A). However, her stridor became more severe and laryngoscopy was re-performed and revealed subglottic stenosis progression prompting emergency tracheotomy (Figure 2B).
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Laryngoscopic findings after tracheostomy. (A) On POD 5, laryngoscopy of the glottis through the tracheostomy orifice suggested progressive subglottic stenosis. (B) On POD 7, laryngoscopy of the glottis through the tracheostomy orifice revealed almost complete airway obstruction. (C) On POD 9, laryngoscopy of the glottis through the tracheostomy orifice indicated partial improvement in the subglottic stenosis. (D) On POD 12, laryngoscopy of the glottis through the tracheostomy orifice revealed almost complete resolution of the subglottic stenosis. POD, postoperative day.
On POD 5, subglottic stenosis progressed further (Figure 3A). By POD 7, observation of the glottis through the tracheostomy orifice revealed almost complete airway obstruction (Figure 3B). By POD 9, partially improving the subglottic stenosis (Figure 3C), thereafter the subglottic stenosis was almost completely alleviated by POD 12 (Figure 3D) (Figure S1A,S1B) and gradual improvement continued (Figure S1C).
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Initial contact during the WSP, from a posterior view
Figures 1 and 2 show images of the subject's pitching mechanics during initial foot contact from posterior and lateral views, respectively.
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(A) Inset of right RFF-STSG over right groin defect. (B) Four months postoperative. Well-healed RFF-STSG over right groin.
After operative hematoma evacuation and debridement, microbiology culture sampling and wash out, the PRS team utilized a right pedicled RFF with STSG for coverage of the exposed graft (Fig. 2A). After a 6-week hospitalization including rehabilitation, the patient was discharged home and ultimately completed a 6-week course of intravenous antibiotics (Fig. 2B).
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