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T1 Age 2 13 50-year-old T2 Sex 14 18 lady T3 Clinical_event 19 28 presented E1 Clinical_event:T3 T4 Sign_symptom 48 52 pain E2 Sign_symptom:T4 T5 Biological_structure 53 60 abdomen R1 MODIFY Arg1:T5 Arg2:E2 T6 Sign_symptom 65 73 jaundice E3 Sign_symptom:T6 T7 Duration 78 99 one and a half months E4 Duration:T7 T8 Sign_symptom 145 150 fever E5 Sign_symptom:T8 T9 Detailed_description 124 136 intermittent R2 MODIFY Arg1:T9 Arg2:E5 T10 Duration 158 169 last 1 week E6 Duration:T10 T11 Diagnostic_procedure 171 191 Physical examination E7 Diagnostic_procedure:T11 T12 Sign_symptom 213 220 icterus E8 Sign_symptom:T12 #1 AnnotatorNotes E8 jaundice T13 Sign_symptom 252 256 mass E9 Sign_symptom:T13 T14 Shape 243 251 globular R3 MODIFY Arg1:T14 Arg2:E9 T15 Detailed_description 236 242 tender T16 Detailed_description 227 235 palpable R4 MODIFY Arg1:T15 Arg2:E9 R5 MODIFY Arg1:T16 Arg2:E9 T17 Biological_structure 264 283 right hypochondrium R6 MODIFY Arg1:T17 Arg2:E9 T18 Area 294 302 3 × 3 cm R7 MODIFY Arg1:T18 Arg2:E9 T19 Sign_symptom 340 348 jaundice E10 Sign_symptom:T19 T20 Detailed_description 328 339 obstructive R8 MODIFY Arg1:T20 Arg2:E10 T21 Disease_disorder 362 385 periampullary carcinoma E11 Disease_disorder:T21 T22 Diagnostic_procedure 396 424 Ultrasonographic examination E12 Diagnostic_procedure:T22 T23 Biological_structure 432 439 abdomen R9 MODIFY Arg1:T23 Arg2:E12 T24 Biological_structure 444 450 pelvis R10 MODIFY Arg1:T24 Arg2:E12 T25 Sign_symptom 460 507 dilatation of the intrahepatic biliary radicles E13 Sign_symptom:T25 T26 Biological_structure 478 507 intrahepatic biliary radicles T27 Biological_structure 509 513 IHBR R11 IDENTICAL Arg1:T27 Arg2:T26 R12 MODIFY Arg1:T26 Arg2:E13 T28 Sign_symptom 544 555 gall stones E14 Sign_symptom:T28 T29 Detailed_description 537 543 mobile T30 Detailed_description 521 529 multiple R13 MODIFY Arg1:T30 Arg2:E14 R14 MODIFY Arg1:T29 Arg2:E14 T31 Sign_symptom 562 586 dilated common bile duct E15 Sign_symptom:T31 T32 Biological_structure 570 586 common bile duct T33 Biological_structure 588 591 CBD R15 IDENTICAL Arg1:T33 Arg2:T32 T34 Distance 603 609 1.8 cm T35 Detailed_description 615 649 sudden narrowing at its distal end R16 MODIFY Arg1:T34 Arg2:E15 R17 MODIFY Arg1:T35 Arg2:E15 T36 Diagnostic_procedure 651 658 CT scan E16 Diagnostic_procedure:T36 T37 Sign_symptom 675 732 dilatation of the extra and intrahepatic biliary radicles E17 Sign_symptom:T37 T38 Severity 666 674 moderate R18 MODIFY Arg1:T38 Arg2:E17 T39 Sign_symptom 734 748 cholelithiasis E18 Sign_symptom:T39 #2 AnnotatorNotes E18 Gallstones T40 Sign_symptom 765 800 thickening of the gall bladder wall E19 Sign_symptom:T40 T41 Biological_structure 808 814 fundus R19 MODIFY Arg1:T41 Arg2:E19 T42 Sign_symptom 833 842 stricture E20 Sign_symptom:T42 T43 Biological_attribute 822 832 distal CBD R20 MODIFY Arg1:T43 Arg2:E20 T44 Sign_symptom 881 891 metastasis E21 Sign_symptom:T44 A1 POLARITY E21 NEG T45 Disease_disorder 929 952 periampullary carcinoma E22 Disease_disorder:T45 T46 Disease_disorder 958 979 chronic cholecystitis E23 Disease_disorder:T46 #3 AnnotatorNotes E23 this is a disease because it's chronic T47 Therapeutic_procedure 1020 1043 pancreaticoduodenectomy E24 Therapeutic_procedure:T47 T48 Therapeutic_procedure 1045 1064 Whipple’s procedure E25 Therapeutic_procedure:T48 R21 IDENTICAL Arg1:E25 Arg2:E24 T49 Clinical_event 1006 1013 planned E26 Clinical_event:T49 T50 Therapeutic_procedure 1120 1139 Whipple’s procedure E27 Therapeutic_procedure:T50 T51 Diagnostic_procedure 1141 1158 table examination E28 Diagnostic_procedure:T51 T52 Biological_structure 1166 1183 resected specimen R22 MODIFY Arg1:T52 Arg2:E28 T53 Sign_symptom 1202 1213 gall stones E29 Sign_symptom:T53 T54 Detailed_description 1193 1201 multiple T55 Biological_structure 1221 1233 gall bladder R23 MODIFY Arg1:T54 Arg2:E29 R24 MODIFY Arg1:T55 Arg2:E29 T56 Sign_symptom 1247 1265 mucosal thickening E30 Sign_symptom:T56 T57 Biological_structure 1273 1279 fundus R25 MODIFY Arg1:T57 Arg2:E30 T58 Sign_symptom 1313 1319 growth E31 Sign_symptom:T58 T59 Detailed_description 1287 1296 irregular T60 Detailed_description 1297 1312 circumferential R26 MODIFY Arg1:T60 Arg2:E31 R27 MODIFY Arg1:T59 Arg2:E31 T61 Biological_structure 1334 1368 intrapancreatic portion of the CBD R28 MODIFY Arg1:T61 Arg2:E31 T62 Therapeutic_procedure 1370 1390 Postoperative period E32 Therapeutic_procedure:T62 T63 Lab_value 1395 1405 uneventful R29 MODIFY Arg1:T63 Arg2:E32 T64 Clinical_event 1423 1432 recovered E33 Clinical_event:T64 T65 Lab_value 1433 1447 satisfactorily R30 MODIFY Arg1:T65 Arg2:E33 T66 Diagnostic_procedure 1449 1478 Histopathological examination E34 Diagnostic_procedure:T66 T67 Biological_structure 1486 1503 resected specimen R31 MODIFY Arg1:T67 Arg2:E34 T68 Sign_symptom 1529 1564 thickening of the gall bladder wall E35 Sign_symptom:T68 T69 Biological_structure 1572 1578 fundus R32 MODIFY Arg1:T69 Arg2:E35 T70 Sign_symptom 1599 1606 calculi E36 Sign_symptom:T70 #4 AnnotatorNotes E36 stones T71 Detailed_description 1593 1598 small T72 Detailed_description 1584 1592 multiple R33 MODIFY Arg1:T71 Arg2:E36 R34 MODIFY Arg1:T72 Arg2:E36 T73 Distance 1630 1636 1.4 cm R35 MODIFY Arg1:T73 Arg2:E36 T74 Disease_disorder 1721 1735 adenocarcinoma E37 Disease_disorder:T74 A2 POLARITY E37 UNCERTAIN T75 Biological_structure 1751 1757 mucosa R36 MODIFY Arg1:T75 Arg2:E37 T76 Diagnostic_procedure 1759 1779 Microscopic sections E38 Diagnostic_procedure:T76 T77 Disease_disorder 1823 1837 adenocarcinoma E39 Disease_disorder:T77 T78 Biological_structure 1845 1861 common bile duct R37 MODIFY Arg1:T78 Arg2:E39 T79 Biological_structure 1798 1815 distal CBD region R38 MODIFY Arg1:T79 Arg2:E38 T80 Detailed_description 1867 1875 invasion R39 MODIFY Arg1:T80 Arg2:E39 T81 Biological_structure 1885 1914 muscular wall of the duodenum R40 MODIFY Arg1:T81 Arg2:T80 T82 Diagnostic_procedure 1916 1924 Sections E40 Diagnostic_procedure:T82 T83 Biological_structure 1942 1962 resected lymph nodes R41 MODIFY Arg1:T83 Arg2:E40 T84 Sign_symptom 1976 1987 tumor cells E41 Sign_symptom:T84 A3 POLARITY E41 NEG R42 MODIFY Arg1:E41 Arg2:E40 T85 Medication 2163 2179 adjuvant therapy E42 Medication:T85 A4 POLARITY E42 NEG T86 Date 2210 2231 2 years after surgery E43 Date:T86 T87 Sign_symptom 2197 2204 disease E44 Sign_symptom:T87 A5 POLARITY E44 NEG T88 Disease_disorder 2028 2042 adenocarcinoma E45 Disease_disorder:T88 T89 Biological_structure 2050 2062 gall bladder R43 MODIFY Arg1:T89 Arg2:E45 T90 Detailed_description 2015 2023 pT1aN0M0 R44 MODIFY Arg1:T90 Arg2:E45 T91 Disease_disorder 2079 2093 adenocarcinoma E46 Disease_disorder:T91 T92 Biological_structure 2101 2111 distal CBD R45 MODIFY Arg1:T92 Arg2:E46 T93 Detailed_description 2067 2074 pT2N0M0 R46 MODIFY Arg1:T93 Arg2:E46 R47 AFTER Arg1:E1 Arg2:E2 * OVERLAP E2 E3 E4 R48 BEFORE Arg1:E4 Arg2:E5 * OVERLAP E5 E6 R49 BEFORE Arg1:E6 Arg2:E7 * OVERLAP E7 E8 E9 E10 E11 E12 E13 E14 E15 E16 E17 E18 E19 E20 E21 R50 BEFORE Arg1:E21 Arg2:E22 * OVERLAP E22 E23 E26 E24 R51 BEFORE Arg1:E24 Arg2:E27 R52 BEFORE Arg1:E27 Arg2:E28 * OVERLAP E28 E29 E30 E31 E32 E33 E34 E35 E36 E37 E38 E39 E40 E41 E45 E46 E42 R53 BEFORE Arg1:E42 Arg2:E44 * OVERLAP E44 E43