Bibliographic record
Abstract
Case Report An 81-year-old man with alcoholic cirrhosis presented with hematemesis, melena, and hypotension. Examination revealed ascites and chronic liver disease stigmata. Esophagogastroduodenoscopy (EGD) revealed multiple large columns of esophageal varices. No other bleeding sources were seen. Using a Cook 4, 6, 10 Shooter® (Cook Medical, Bloomington, IN) multi-band ligator, the varix was ligated at the site of a platelet plug, which suggested recent hemorrhage (Figure 1). After blood extruded at the site of this defect, the ligated varix demonstrated the white ball sign (Figure 2). First described by Matsutani and colleagues, the white ball sign is observed after effective variceal ligation at the bleeding site.1-3 It is hypothesized that the outflow of blood from the rupture point on the varix is the likely cause of this phenomenon.1-3 Ligation at non-bleeding sites results in a purple ball appearance, representing congestion of blood in the variceal vessels captured by the band.3 Other authors have noted that the white ball sign also occurs with ligation of the bleeding point on esophogogastric varices.3 In the setting of variceal bleeding where the bleeding point is obscure, the white ball sign is particularly useful in confirming effective ligation.1Figure 1.: Appearance of varix after ligation with a Cook 4, 6, 10 Shooter® multi-band ligator suggesting recent hemorrhage.Figure 2.: The ligated varix demonstrated the white ball sign after blood extruded at the site of this defect.Disclosures Author contributions: C. Dargavel wrote the manuscript and, along with SC Grover, revised the manuscript for intellectually important content. SC Grover obtained the endoscopic images, approved the final manuscript, and is the article guarantor. Financial disclosure: None to report. Informed consent was obtained for this case report. Received: December 2, 2013; Accepted: March 18, 2014
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.006 | 0.005 |
| Insufficient payload (model declined to judge) | 0.008 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".