Cases reported "Chronic Disease"

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1/291. Diffuse alopecia with stem cell folliculitis: chronic diffuse alopecia areata or a distinct entity?

    A 34-year-old woman presented with an 8-year history of slowly progressive diffuse nonscarring alopecia with loss of hair density. scalp biopsy specimens showed increased miniaturized follicles and an asymmetric wedge-shaped lymphocytic infiltrate concentrated on the stem cell-rich region at the point of entry of sebaceous ducts and at bulge-like regions of multiple follicles. Several hair bulbs emerging at the stem cell compartment also were inflamed, but the hair bulbs in the deeper dermis and subcutis were spared. I speculate whether these findings may represent a stem cell folliculitis similar to the reaction pattern previously observed in graft versus host disease and in androgenetic alopecia. The additional presence of peribulbar lymphocytic inflammation could indicate that the patient had a variant of alopecia areata. The clinical presentation of a slowly progressive diffuse alopecia without progression to clinically recognizable alopecia areata and the prominent lymphocytic inflammation involving the stem cell compartment may prompt a reexamination of similar cases currently classified as chronic diffuse alopecia areata. The concept that lymphocytes can inhibit stem cell function without destroying the stem cells themselves needs consideration.
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keywords = deep
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2/291. The development of a pancreatic abscess, suppurative pylethrombosis, and multiple hepatic abscesses after a pancreatojejunostomy for chronic pancreatitis: report of a case.

    We present herein an autopsy case of 63-year-old Japanese man who died as a result of pancreatic abscess, suppurative pylethrombosis, and multiple liver abscesses that had developed 10 years after a pancreato- and cystojejunostomy with side-to-side anastomosis for chronic pancreatitis. Even after this operation, the patient had continued to consume excessive amounts of alcohol. He had first experienced back pain with leukocytosis 9 years after the operation, which relapsed the following year. Despite percutaneous transhepatic gallbladder drainage, his icterus had deteriorated into hepatic insufficiency. Computed tomographic scans of the abdomen had disclosed multiple liver abscesses. At autopsy, a pancreatic abscess and suppurative pylethrombosis as well as multiple liver abscesses were found. There have been few reported cases of such lethal complications developing after a pancreato- and cystojejunostomy for chronic pancreatitis. As the consumption of alcohol would have exacerbated the chronic pancreatitis, such patients should be strongly advised to abstain from drinking alcohol.
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ranking = 425.57258296743
keywords = thrombosis
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3/291. Aortic dissection of Kommerell's diverticulum in Marfan's syndrome.

    We report a surgical case of chronic aortic dissection with an entrance tear on Kommerell's diverticulum, a rare embryologic anomaly, with an extension to the arteria lusoria, in a patient with Marfan's syndrome. The operation consisted of aortic root and arch replacement with reimplantation of the right subclavian artery in the right carotid artery under circulatory arrest and deep hypothermia.
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4/291. Possibility of focal activation around the left upper pulmonary vein during chronic atrial fibrillation with mitral valve disease.

    Focal regular activations were sometimes observed during chronic atrial fibrillation (AF) associated with mitral valve disease. We present a 58 year-old male diagnosed with mitral valvular stenosis and regurgitation with chronic atrial fibrillation. Intraoperative mapping of both atria was performed during mitral valvular surgery. Regular and repetitive activations around the left superior pulmonary vein were observed, in contrast to irregular and chaotic activations of the right atrium. This regular activation was supposed to be the focus of chronic AF. Surgical ablation of the posterior left atrium was successfully performed and eliminated the chronic AF, concomitant with mitral valve replacement.
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ranking = 27.070807692172
keywords = vein
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5/291. A successful case of pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension with a thrombus in the right ventricle.

    Chronic thromboembolism is a frequent cause of progressive hypertension and carries a poor prognosis. Medical treatment is not effective and surgery provides the only potential for a cure at present. We herein report a successful case of thromboendarterectomy treated via a median sternotomy with intermittent circulatory arrest. A 43-year-old man was admitted to our hospital complaining of progressive dyspnea, edema of the lower extremities, and a fever with an unknown origin. A subsequent definitive evaluation showed him to be suffering from surgically accessible chronic thromboembolic pulmonary hypertension with a thrombus in the right ventricle. He underwent a pulmonary thromboendarterectomy and thrombectomy via a median sternotomy with intermittent circulatory arrest on November 24, 1994. Postoperatively he showed a marked improvement in his hemodynamic status and blood gas analysis. He has also returned to work with no trouble. Deep vein thrombosis appeared to be the pathogenesis of this case, but we could not find the origin of his unknown fever. He is currently being controlled by treatment with methylprednisolone as before.
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ranking = 85.842613167194
keywords = thrombosis, vein thrombosis, vein
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6/291. Midbrain infarction: a rare presentation of cryptococcal meningitis.

    A 20-year-old farmer who had headache and fever for 1 month, suddenly developed left hemiplegia, tremor in left arm and titubation followed by deep coma. Cranial CT scan revealed an infarction in right crus of midbrain. His CSF revealed 66 mg/dl protein, 10 lymphocytes/mm3, and 70 mg/dl glucose. CSF was positive for cryptococcal antigen. He improved following i.v. amphotericin 0.5 mg/kg and fluconazole 200 mg daily, continued for 6 and 12 weeks respectively. Infarctions though rare in cryptococcal meningitis should be considered in patients with chronic meningitis with vasculitis.
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keywords = deep
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7/291. pancreaticoduodenectomy for chronic pancreatitis: a case report and literature review.

    This is a case report of a patient with chronic pancreatitis who presented with biliary, duodenal and portal vein obstruction, a mass in the head of the pancreas, and a CA 19-9 level of 372 U/ml. Thus, the concern was raised as to the possibility of pancreatic cancer in this patient. We discuss the difficulties in the diagnosis of pancreatic cancer in patients with chronic pancreatitis and the treatment options available for patients with chronic pancreatitis where the significant findings involve the head of the pancreas. Finally, a brief review is given describing the pertinent literature on the surgical treatment of chronic pancreatitis and the current indications of pancreaticoduodenectomy for chronic pancreatitis.
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ranking = 5.4141615384344
keywords = vein
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8/291. anemia due to massive chronic foetomaternal hemorrhage.

    We report a case of massive chronic foetomaternal hemorrhage. The labor course was uncomplicated. The newborn presented with pallor. tachypnea, and moderate hepatosplenomegaly. The initial hemoglobin was 6.5 g/dl. The Kleihauer-Betke stain on a maternal blood sample was 12%, which is equivalent to 540 ml of fetal blood in the maternal circulation. A clot in the umbilical vein was demonstrated sonographically. The possible association of foetomaternal hemorrhage with umbilical vein thrombosis is discussed.
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ranking = 91.256774705629
keywords = thrombosis, vein thrombosis, vein
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9/291. Laryngeal sarcoidosis presenting as an isolated submucosal vocal fold mass.

    sarcoidosis can affect the larynx as a manifestation of systemic disease or as isolated laryngeal involvement. Classically, laryngeal involvement affects the supraglottis, and less commonly the subglottis, and true vocal fold involvement is rare. The clinical course is often highlighted by frequent exacerbations and remissions that, when associated with vague complaints and constitutional symptoms, are probably the greatest contributor to delayed presentation and diagnosis. We describe an unusual case of sarcoidosis that presented after a long and protracted clinical course as an isolated submucosal vocal fold mass requiring deep biopsy for diagnosis. A review of the literature with emphasis on diagnosis, appropriate airway management, and treatment is presented.
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ranking = 1
keywords = deep
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10/291. Spontaneous thrombosis of a pseudoaneurysm complicating pancreatitis.

    patients with a visceral aneurysm are at high risk for acute transpapillary, intra-, or retroperitoneal hemorrhage, necessitating either surgical or endovascular therapy. We report an instance of spontaneous thrombosis of a pseudoaneurysm complicating pancreatitis before endovascular treatment could be performed. causality and the literature of spontaneous thrombosis in pseudoaneurysms are discussed.
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ranking = 425.57258296743
keywords = thrombosis
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