private static String highlightContent(String qID, String content) {
Hashtable<Integer, String> usedColors = new Hashtable<Integer, String>();
Hashtable<String, String> wordColors = new Hashtable<String, String>();
StringBuilder sb = new StringBuilder();
String query = topicHash.get(qID);
if (content != null) {
// highlight keywords
String[] terms = query.split("[() \t,;|?-]+");
Document document = parser.parse(content);
Paragraph p = document.getFirstParagraph();
while (p != null) {
Sentence s = p.getFirstSentence();
while (s != null) {
Word word = s.getFirstWord();
while (word != null) {
String token = word.getContent();
if (word.isWord()) {
if (token.length() > 1
&& (stopwords.get(token.toLowerCase()) == null)) {
// search this token in the query
for (String term : terms) {
String stemmedTerm = StringProcessing
.getStem(token, stemmer)
.toLowerCase();
if (token.equalsIgnoreCase(term)
|| stemmedTerm
.equals(StringProcessing
.getStem(term,
stemmer))) {
String color = getNewColor(usedColors,
wordColors, stemmedTerm);
word.setContent(String
.format("<span style=\"font-weight:bold;color:%s\">%s</span>",
color, token));
// highlight this term in the query
int oldQueryLength = query.length();
query = query
.replace(
" " + term + " ",
String.format(
" <span style=\"color:%s\">%s</span> ",
color, term));
if (oldQueryLength == query.length()) {
query = query
.replace(
" " + term,
String.format(
" <span style=\"color:%s\">%s</span>",
color, term));
}
if (oldQueryLength == query.length()) {
query = query
.replace(
term + " ",
String.format(
"<span style=\"color:%s\">%s</span> ",
color, term));
}
if (oldQueryLength == query.length()) {
query = query
.replace(
term + "-",
String.format(
"<span style=\"color:%s\">%s</span>-",
color, term));
}
if (oldQueryLength == query.length()) {
query = query
.replace(
"-" + term,
String.format(
"-<span style=\"color:%s\">%s</span>",
color, term));
}
}
}
}
}
word = word.next;
}
s = s.next;
}
p = p.next;
}
// rebuild the content with highlighted terms
p = document.getFirstParagraph();
while (p != null) {
Sentence s = p.getFirstSentence();
while (s != null) {
Word word = s.getFirstWord();
while (word != null) {
sb.append(word.getContent());
word = word.next;
if (word != null) {
if (word.isWord() || word.isNumber()) {
sb.append(" ");
}
}
}
sb.append("\n");
s = s.next;
}
sb.append("\n");
p = p.next;
}
}
sbQuery = new StringBuilder(query);
return sb.toString();
}
public static String getNewColor(Hashtable<Integer, String> usedColors,
Hashtable<String, String> wordColors, String word) {
// check if this word has been colored or not
String color = wordColors.get(word);
if (color != null) {
return color;
}
int i = usedColors.size();
while ((i < colorHash.size() - 1) && (usedColors.get(i) != null)) {
i++;
}
color = colorHash.get(i);
if (color == null) {
color = "black";
}
// set color status to 'used'
usedColors.put(i, color);
wordColors.put(word, color);
return color;
}
Given a query, this method aims at highlighting query terms appearing in the original query and the returned documents for that query.
See the examples below:
Example 1:
Query 21
A 21-year-old female is evaluated for progressive arthralgias and malaise On examination she is found to have alopecia a rash mainly distributed on the bridge of her nose and her cheeks a delicate non-palpable purpura on her calves and swelling and tenderness of her wrists and ankles Her lab shows normocytic anemia thrombocytopenia a 4 4 positive ANA and anti-dsDNA Her urine is positive for protein and RBC casts
Document 3138087
A Case of Thrombotic Thrombocytopenia Purpura Associated with Systemic Lupus Erythematosus: Diagnostic Utility of ADAMTS- 13 Activity Thrombotic thrombocytopeniapurpura( TTP) caused by a deficiency in ADAMTS- 13 activity is considered to involve a subset of thrombotic microangiopathy( TMA) Although concept of TTP is included under the umbrella of TMA, discrimination of TTP from TMA is occasionally difficult in an autoimmune disorder Herein, we report a case with TTP associated with systemic lupus erythematosus( SLE) In this case, it was difficult to discriminate TTP from TMA and the measurement of ADAMTS- 13 activity was useful for obtaining an accurate diagnosis SLE patients having thrombocytopenia in complication with anemia should be considered a monitoring of ADAMTS- 13 activity even though the patients lacked symptoms of TTP related to the microvascular coagulation 1 IntroductionThrombotic thrombocytopenic purpura( TTP) is a life- threatening syndrome first described by Moschocowitz in 1924[ 1] TTP is clinically characterized by five typical syndromes: thrombocytopenia with platelet consumption, hemolytic anemia characterized by schistocytes, renal impairment, neurological abnormalities, and fever The classic pentad described above is observed in as few as 40% of TTP patients[ 2], and the clinical course of the syndrome is usually rapid, therefore, an accurate diagnosis and immediate treatment including plasma exchange is necessary[ 3] Von Wiilebrand factor-( vWF)- specific metalloprotease, a disintegrin- like and metalloprotease with thrombospondin type 1 motif- 13( ADAMTS- 13) is known to play an important role in the pathogenesis of TTP[ 4–6] A severe deficiency of ADAMTS- 13 activity prevents the physiological processing of large vWF multimers which can lead to a strong platelet aggregation, and leads to the formation of microthrombosis in terminal arterioles and capillaries Besides TTP, microthrombosis without a deficiency in ADAMTS- 13 activity can also be associated with other diseases such as hemolytic uremic syndrome( HUS), various autoimmune diseases, cytotoxic drugs, human immunodeficiency virus( HIV), malignancies, disseminating intravascular coagulopathy( DIC), and pre- eclampsia[ 7] Recently, these pathological conditions characterized by microthrombosis including TTP, have been classified as thrombotic microangiopathies( TMA) In autoimmune disorders, TMA occasionally occurs in systemic lupus erythematosus( SLE), antiphospholipid antibody syndrome( APS)[ 8, 9], and in many rare autoimmune disorders[ 7] Rigorous classification of TMA is important to decide on the appropriate therapy In particular, the combination of TTP and SLE has been reported to show a worse prognosis than SLE or idiopathic TTP alone[ 10], therefore, an accurate diagnosis and an immediate treatment are required. Taken together, we recently encountered a case of SLE associated with TTP This case indicated the diagnostic difficulty of TTP associated with autoimmune diseases such as SLE and the diagnostic efficacy of immediate monitoring of ADAMTS- 13 activity for distinguishing TTP from other TMA 2 Case ReportA 15- year- oldfemale was admitted to our hospital because of thrombocytopenia with hemolytic anemia She had noticed small purpura on her arms and her legs during 2 weeks before the admission At the same time, she started having headaches, polyarthritis, and shortness of breath on exertion These symptoms progressively deteriorated, thus prompting her hospital visit On her physical examination, body temperature was 38. 2°C Her consciousness was alert Small purpura were scattered over her entire arms and legs A malar rash was also recognized on her face Broad spectrum antibiotic( doripenem hydrate, 1. 5 g/ day) was involved in the initial therapy because severe bacterial infection was suspected in the situation with undetermined diagnosis on the admission However, bacterial cultures from her blood, urine, sputum, and throat swab revealed no signs of any bacterial infections and we subsequently excluded bacterial infection from the diagnosis Titers of antibodies against various kinds of virus such as cytomegalovirus, Epstein- Barr virus, and parvovirus B19 were also negative Laboratory findings revealed thrombocytopenia with hemolytic anemia A summary of the laboratory tests on admission is shown in Table 1 The serum hemoglobin level was low at 6. 4 g/ dL( normal range 12. 0–16. 0 g/ dL), her platelet count was also low at 4000/ μL( normal range 15. 0–35. 0 × 104/ μL) The number of white blood cells was within normal range Although the serum levels of fibrinogen degradation products( FDP) and D- dimers were elevated to 17. 4 μg/ dL( normal range less than 5. 0 μg/ dL) and 8. 78 μg/ dL( normal range less than 2. 0 μg/ dL), respectively, suggesting DIC, the other parameters related to DIC, such as the serum level of fibrinogen, prothrombin time( PT), and activated partial thromboplastin time( aPTT) were normal The serum level of lactate dehydrogenase( LDH) was elevated to 915 IU/ L( normal range 119–219 IU/ L), and that of total bilirubin level was also elevated at 2. 9 mg/ dL( normal range 0. 2–1. 3 mg/ dL) with dominant elevation of indirect bilirubin The blood urea nitrogen( BUN) and creatinine levels were within the normal range and urinalysis did not show any abnormal findings Although her serum haptoglobin levels were decreased at less than 10 mg/ dL( normal range > 43–180) thus suggesting hemolytic anemia, both the direct and indirect Coombs tests were negative The patient' s bone marrow cells obtained by aspiration revealed normal differentiation, however, a peripheral blood smear test clearly showed schistocytes in the RBC Her antinuclear antibody( ANA) test was positive, and she also had anti- DNA antibodies, anti- SS- A antibodies, anti- RNP antibodies, and anticardiolipin antibodies Her serum complement levels were decreased( CH50 21U/ mL, C3 81 mg/ dL, and C4 8 mg/ dL, normal range CH50 32–49 U/ mL, C3 65–135 mg/ dL, C4 13–35 mg/ dL, resp.) and increased immune complex formation was observed( ICc1q 3. 3 μg/ mL, normal range 0–3. 0 μg/ mL) She thus fulfilled the criteria for systemic lupus erythematosus( SLE) based on these laboratory findings( positive for ANA, anti- DNA antibody, anti- cardiolipin antibody, and thrombocytopenia) and her symptoms, such as malar rash and polyarthritis At this moment, her SLE disease activity score( SLEDAI) was 13, thus indicating high disease activity On admission, TMA, seronegative autoimmune hemolytic anemia with thrombocytopenia( EVANS syndrome), CAPS, and DIC were considered as possible candidates for her thrombocytopenia with hemolytic anemia We provisionally diagnosed her illness as TMA with complicated autoimmune disorder because of a negative Coombs test, hemolytic anemia with schistocytes and thrombocytopenia, and immunosuppressive therapies, which consisted of intravenous cyclophosphamide administration( 500 mg/ body) and intravenous methylprednisolone( 1000 mg/ body, 3 days) administration followed by oral administration of prednisolone( 50 mg/ day), were initially introduced However, the immunosuppressive therapy did not ameliorate her illness, therefore, we suspected TTP As expected, additional laboratory tests showed that her serum ADAMTS- 13 activity was obviously suppressed to an undetectable level Although she did not have typical symptoms of TTP such as renal dysfunction and abnormalities of the central nervous system, we diagnosed her illness as TTP Plasma exchange therapy was immediately added to her treatment The therapy was continued for 5 consecutive days, then, her symptoms and the abnormal findings of laboratory tests completely disappeared The clinical course of the patient is summarized and illustrated in Figure 1 The serum level of ADAMTS- 13 activity was restored from an undetectable level to 60% of normal on day 17, and 168% on day 47, concomitant with the disease amelioration She was discharged without any symptoms 3 DiscussionWe herein reported a case of SLE associated with TTP Because the patient lacked variable signs/ symptoms of organ ischemia related to thrombosis in capillary arteries, it was difficult to determine the diagnosis of TTP at presentation She was diagnosed with SLE based on her physical and laboratory findings( such as a malar rash, polyarthralgia, increased levels of several autoantibodies, and decreased serum complement concentrations) Decreased levels of ADAMTS- 13 indicated that she had been suffering from TTP as well, and that her TTP contributed to the development of her thrombocytopenia and hemolytic anemia TTP is classified as congenital and acquired type Whereas congenital ADAMTS- 13 deficiency is rare, loss of ADAMTS- 13 activity is observed more frequently in acquired TTP The ADAMTS- 13 deficiency can be caused by an autoantibody and various other factors having an inhibitory effect on ADAMTS- 13 activity[ 4] Although the loss of ADAMTS- 13 activity is the most important factor for diagnosis of TTP, it has been reported a few diseases condition resulted in ADAMTS- 13 deficiency other than TTP Nguyen and coworkers has reported that patients with severe sepsis revealed reduced ADAMTS- 13 activity and the deficiency correlated with severity of thrombocytopenia and plasma level of interleukin- 6( IL- 6)[ 11] Indeed, mild- to- moderate ADAMTS- 13 deficiency has been detected in systemic inflammation[ 12] These reports suggest that inflammatory cytokines contribute to the deficiency of ADAMTS- 13 Patients with SLE have been known to have an elevated serum level of cytokines due to aberrant activation of autoreactive lymphocytes In the present case, some kind of cytokines may play an important role for deficiency of ADAMTS- 13 in coordination with a production of inhibitory autoantibody against ADAMTS- 13 Moreover, Lattuada et al has reported that pregnant woman with HELLP syndrome( hemolytic anemia, elevated liver enzyme, and low platelets) had lower plasma levels of ADAMTS- 13 activity[ 13] Although some of clinical presentation TTP are shared by patients with severe sepsis and HELLP syndrome, the effective treatments differ in each diseases even though the deficiency of ADAMT- 13 are observed in common with these diseases No matter ADAMTS- 13 deficiency observed, we should still take a possibility of other diseases condition into account in addition to TTP Although plasma exchange is the most effective treatment of TTP, it also can be used in other clinical manifestations related to SLE Pugnoux et al have reported that plasma exchange has beneficial effects for SLE- related diseases such as neurolupus, alveolar hemorrhage, and severe lupus nephritis[ 14] Furthermore, Cerdas- Quesada have reported that refractory AIHA was successfully treated with plasma exchange[ 15] The clinical manifestations of these diseases are shared with those of TTP The rationale to use plasma exchange for the disease state is a removal of pathological autoantibodies, cytokines, and unknown harmful factors In addition to TTP, the plasma exchange may be used for other complications of SLE as a supportive treatment until immunosuppressive therapy become effective If immediate curative effects are required, plasma exchange may be an important strategy for certain SLE- rerated diseases even though TTP does not exist. Similar to our case, autoimmune disorder occasionally makes it difficult to diagnose TTP, especially in the patients lacking typical clinical signs/ symptoms of the disease Moreover, it may be difficult to distinguish TTP from the other types of TMA The possible differential diagnosis and the clinical differences among representative TMA including TTP are summarized in Table 2 HUS is characterized as renal diseases and usually associated with bacterial colitis( Escherichia coli O157 and Shigella- toxin- producing strain) HUS can be distinguished from TTP by diarrhea( D+ HUS) Our patient had not shown any digestive symptoms however, diarrhea negative( D- HUS) cases of HUS have been reported EVANS syndrome, which is characterized by autoimmune hemolytic anemia( AIHA) with autoimmune thrombocytopenia, is also considered as one of important differential diagnosis from TTP The detection of RBC bound immunoglobulin G and complement by the direct antiglobulin test( DAT Coombs test) is useful in the diagnosis of AIHA[ 16] The Coombs test in our patient was negative, although a small number of patients with AIHA have been reported to show a negative DAT[ 17], probably because of the lower affinity of IgG to RBC[ 18] Therefore, the lack of these autoantibodies cannot conclusively exclude AIHA and/ or EVANS syndrome Catastrophic antiphospholipid syndrome( CAPS) which is an accelerated from APS[ 19] is a relatively new entity and thought to be a rare disease, although the exact thrombogenic mechanisms of CAPS remain unclear The treatment of CAPS is not currently standardized and the prognosis is poor with death occurring in 50% of patients[ 20] The diagnosis of TTP in patients with SLE could be difficult in SLE cases of positive for antiphospholipid antibody In fact, laboratory findings in our patient revealed positivity for aCL, ...
Example 2:
Query 22 - A 15-year-old girl presents to the ER with abdominal pain. The pain appeared gradually and was periumbilical at first localizing to the right lower quadrant over hours. She has had no appetite since yesterday but denies diarrhea She has had no sexual partners and her menses are regular On examination she has localized rebound tenderness over the right lower quadrant. On an abdominal ultrasound a markedly edematous appendix is seen.
Document 2365938 Cecal diverticulitis mimicking acute Appendicitis: a report of 4 cases Diverticulum of the cecum is a rare, benign, generally asymptomatic lesion that manifests itself only following inflammatory or hemorrhagic complications Most patients with inflammation of a solitary diverticulum of the cecum present with abdominal pain that is indistinguishable from acute appendicitis The optimal management of this condition is still controversial, ranging from conservative antibiotic treatment to aggressive resection We describe four cases that presented with symptoms suggestive of appendicitis, but were found at operation to have an inflamed solitary diverticulum IntroductionThe cecum and ascending colon are infrequently involved in diverticulosis coli The reported frequency is about 1 in 300 appendectomies[ 1, 2] The etiology of cecal diverticulitis remains unclear Even more uncommon is a true solitary dýverticulum, which contains all layers of the bowel wall and is thought to be congenital in origin Preoperative diagnosis is difficult because the symptoms and signs of cecal diverticulitis can mimic acute appendicitis Diagnosis of cecal diverticulitis is difficult to make preoperatively and is thus mostly made intraoperatively The operative treatment of cecal diverticulitis varies greatly in the literature Here we report four cases of true solitary cecal diverticulitis managed with diverticulectomy and appendectomy, and discuss the disease in view of the literature. Case 1A 32- year- old- male was referred to our emergency unit with pain in the right lower quadrant of the abdomen, vomiting, and nausea that began two days prior to admission His body temperature was 37. 8°C The physical examination showed rebound- tenderness in the lower right quadrant of the abdomen Laboratory tests were normal except for high white blood count levels CT scans showed a tumor in the cecum surrounded by an inflammatory plate During the surgical exploration, an enlarged posterolateral wall was seen at the cecum, with a normal appendix A diverticulectomy and incidental appendectomy were performed( Figure 1A, B) The pathological study established the presence of a solitary diverticulum of the cecum with acute diverticulitis. Figure 1A: Intraoperative view B: Postoperative view. Case 2A 26- year- old woman was referred to our hospital after suffering from abdominal pain for four days The progressively increasing pain started from the left hypogastric region and radiated to the lower quadrants She had mild nausea, but no vomiting and no change in bowel habits was observed On physical examination the bowel sounds were decreased Upon palpation there was a muscular defense in the lower quadrants and epigastric fullness Biochemical tests were all within the normal limits and abdominal plain X- rays revealed no abnormality Based on the clinical findings the patient was thus considered to have acute appendicitis and underwent emergency laparotomy At surgery, the appendix was found in the normal location with a normal appearance and a 2 × 3 cm inflamed mass was found on the anterior wall of the cecum located between the tenia libera and plica ileo- cecalis( Figure 2A) A diverticulectomy and incidental appendectomy were performed. Figure 2A: Case 2 B: Case 3 C: Case 4. Case 330- year- old woman presented to the Emergency Department with a pain in right lower abdomen since the day before The pain was continuous in nature There was no history of vomiting, fever, and no change in bowel habits There was a history of decreased appetite and nausea On examination, she was well oriented with a pulse rate of 90/ min and BP of 120/ 70 mmHg The abdomen was soft and non- distended There was tenderness in the right iliac fossa with a positive rebound in the right iliac fossa Bowel sounds and rectal examination were normal Laboratory investigations revealed a Hb of 10. 4 g% and total leukocyte count of 14000 Ultrasound( USG) abdomen was negative except for probe tenderness in the right iliac fossa In view of her history and physical examination, the patient was diagnosed as having acute appendicitis and was shifted to the theatre for an appendectomy The vermiform appendix was absolutely normal and diverticulum was found on the posterior wall of the cecum( Figure 2B) The patient underwent an appendectomy with excision of cecal diverticulum. Case 4A 22- year- old woman was admitted to the hospital with right abdominal pain, nausea and vomiting She mentioned that the abdominal pain had migrated to the right lower abdomen 12 hours after onset of periumbilical pain On physical examination, she was subfebrile( 37. 5°C) and had right lower abdominal tenderness with physical signs of peritonitis Bowel sounds and rectal examination were normal The white blood count was 14200/ mm3 Plain abdominal x- ray and USG findings were normal A preoperative diagnosis of acute appendicitis was made and a laparotomy was performed through a right lower quadrant transverse incision The patient was taken to the theatre where a standard open appendectomy was started During the operation a suspicious mass was found in the lower ascending colon( Figure 2C) The appendix was visualized and found to be normal A diverticulectomy was performed. DiscussionDiverticulosis is extremly common in the United States and Europe It is estimated that half of the population older than age 50 years has colonic diverticula The true prevalenceof colonic diverticulosis is difficult to ascertain, however it appears that about 8. 5% of people in western countries are afflicted[ 1] The sigmoid colon is the most common site of diverticulosis Right- sided diverticula occur more often in younger patients than do left- sided diverticula, and are more common in people of Asian descent than in the other populations The majority of colonic diverticula are false diverticula in which the mucosa and muscularis mucosa have herniated through the colonic wall[ 2] Solitary diverticulum of the cecum is thought to be a congenital lesion arising as a sacular projection during the sixth week of embryonic development[ 2, 3]. Most patients with right side diverticula are asymtomatic However, diverticulitis does occur occasionally Because patients are young and present with right lower quadrant pain, they are often thought to suffer from acute appendicitis, and the diagnosis of right- sided diverticulitis is subsequently made in the operating room It is difficult to differentiate cecal diverticulitis from acute appendicitis More than 70% of patients with cecal diverticulitis were operated on with a preoperative diagnosis of acute appendicitis[ 3] The correct preoperative diagnosis was made in only 5. 3% of 318 patients, according to the report of Wagner and Zollinger[ 4] A number of reviews report that the incidence of a correct intraoperative diagnosis oscillates between 65 and 85%[ 4] In all of our cases except one, the preoperative diagnosis was acute appendicitis. Ultrasound and computer tomography( CT) have both been evaluated in the diagnosis of right- sided diverticulitis Chou et al[ 5] reviewed 934 patients with clinically indeterminate right- sided abdominal pain who went on to have an abdominal ultrasound They reported that ultrasound has demonstrated a sensitivity of 91. 3%, a specificity of 99. 8% and overall accuracy of 99. 5% in the diagnosis of cecal diverticulitis[ 5] CT scans have a sensitivity and specificity of 98% in the diagnosis of acute appendicitis, and are highly cost- effective hence, some authors suggest its routine use for abdominal pain in the right lower quadrant, which would probably reduce surgeries and hospital stays[ 5, 6] Recognition of specific imaging findings enables the radiologist to make the correct diagnosis and helps in establishing the appropriate surgical or medical therapy, thus avoiding unnecessary exploration or surgery for some of these nonsurgical conditions mimicking acute appendicitis If preoperative examination suggests cecum diverticulitis, the most important diagnostic tool is the CT The CT findings were similar to those of left side diverticulitis, including focal pericolonic inflammation, diverticula, colonic wall thickening, thickening of the adjacent fascia, and extraluminal mass effect. In patients with preoperative diagnosis of cecal diverticulitis without signs of peritonitis, medical treatment with antibiotics may be sufficient[ 6, 7] In our cases, almost all of our patients had no history of appendectomy, so appendicitis was the main clinical suspicion in these cases, which led to the operative exploration of the abdomen An intraoperative diagnosis is difficult upon initial exploration In addition, when the diagnosis is made intraoperatively, the surgical management of the disease is controversial Conservative management with antibiotics has been suggested for cecal diverticulitis diagnosed intraoperatively, but most surgeons recommend resection[ 8, 9] In the presence of an inflammatory mass, diverticulectomy is usually impossible, and colectomy is required A literature review of 279 cases of surgically treated cecal diverticulitis found no mortality after ileocecal resection, but a mortality rate of 1. 8% after right hemicolectomy[ 10, 11] Fang et al recommend wide resection, since 29% of patients undergoing only appendectomy in their study had recurrent episodes of right diverticulitis, with 12. 5% of them requiring a later right hemicolectomy[ 11] In all of our patients, a diverticulectomy and incidental appendectomy were performed and postoperative periods were uneventful. In conclusion, Preoperative diagnosis of cecal diverticulitis is important in order to decide how to manage to this condition During the surgical procedure, if the diagnosis of acute appendicitis is in doubt, further exploration should be performed We recommend diverticulectomy as a safe and adequate treatment for cecal diverticulitis However, if the histopathological examination of the specimen reveals the presence of colonic cancer, a right hemicolectomy can always be performed.
/*** Contact me for more details about this method ***/