A toddler with a persisting limp after a minor trauma

2019 ◽  
pp. edpract-2019-317506
Author(s):  
Andrea Trombetta ◽  
Ester Conversano ◽  
Giorgio Cozzi ◽  
Andrea Taddio ◽  
Flora Maria Murru ◽  
...  
Keyword(s):  
White Cell Count ◽  
Surgical Excision ◽  
List Type ◽  
Minor Trauma ◽  
Normal Value ◽  
Reactive Protein ◽  
Oral Ibuprofen ◽  
History Of ◽  
Wait And See ◽  
A Minor

A 3-year-old toddler was admitted for a 5-day history of worsening painful limping on his left leg. History was remarkable only for a minor trauma 2 days before the onset of symptoms; the boy fell on his buttocks but was walking normally in the following days. No fever was reported. Pain was also present at night, with no response to oral ibuprofen.On physical examination, the patient refused to stand on his left leg, palpation of the left buttock evoked pain, and exorotation and abduction of the left hip were only moderately limited, without local signs of inflammation such as redness, swelling or skin warming. Blood tests showed elevated erythrocyte sedimentation rate (ESR) (98 mm/hour, normal value <20 mm/hour) with normal C reactive protein (CRP) level (0.5 mg/dL, normal value <0.5 mg/dL). His white cell count was 12 110 x 109/L, haemoglobin was 127 g/L and PLT was 430 x 109/L. Creatine kinase values were within the normal range.An X-ray of the pelvis was unremarkable. An ultrasound of the left hip showed a 2 mm articular effusion.QuestionsBased on the clinical picture and laboratory tests, what is the most likely diagnosis?Perthes disease.Pyomyositis.Septic arthritis.Bone fracture.Leukaemia.What test could confirm the diagnosis?Bone scintigraphy.CT.Bone marrow aspirate.MRI.Intra-articular puncture.What is the mainstay of management of this condition?Wait and see.Surgical excision.Antibiotic course.Antineoplastic treatment.Answers can be found on page 2.

Adolescent with abdominal pain poorly responsive to analgesia

2020 ◽  
pp. edpract-2020-320772
Author(s):  
Neil Chanchlani ◽  
Philip Jarvis ◽  
James W Hart ◽  
Christine H McMillan ◽  
Christopher R Moudiotis
Keyword(s):  
Abdominal Pain ◽  
Ct Scan ◽  
White Cell Count ◽  
Autism Spectrum ◽  
Free Fluid ◽  
List Type ◽  
Reactive Protein ◽  
Normal Limits ◽  
History Of ◽  
Normal Gallbladder

Case presentationA 14-year-old boy, with autism spectrum disorder, presented with a 1-day history of colicky abdominal pain, non-bilious vomiting, anorexia and loose normal-coloured stool. Two days previously, he had a poorly reheated takeaway chicken.On examination, body mass index (BMI) was >99th centile. He had inconsistent epigastric, periumbilical and umbilical tenderness, and guarding, with normal bowel sounds. Observations were within normal limits, but his pain was poorly responsive to paracetamol, ibuprofen, hyoscine butylbromide, codeine and morphine.Investigations are in table 1. On day 3, his temperature increased to 38.5° and a CT scan was performed, which showed concerning features (figure 1).Table 1Serology and further investigations throughout admissionDay 1Day 2Day 3Day 4Serology White cell count (3.8–10.6×109/L)7.514.615.713.6 Neutrophils (1.8–8.0×109/L)5.312.312.85.3 C reactive protein (<5 mg/L)12010398 Bilirubin (0–21 μmol/L)812Further investigations Urine dipstickNegative UltrasoundSmall volume of free fluid, normal gallbladder, pancreas and appendix not visualisedFigure 1CT scan of the abdomen (A) and pelvis (B).QuestionsWhat is the diagnosis?Appendicitis.Pancreatitis.Cholecystitis.Gastroenteritis.Which serology would have been most helpful at presentation?Renal function.Coagulation.Amylase and lipase.Gamma glutamyltransferase.What are the acute treatment principles?What is the the most common cause?Idiopathic.Gallstones.Medications.Genetic.Answers can be found on page 2.

An adolescent with recurrent ankle swelling

2020 ◽  
pp. edpract-2019-318096
Author(s):  
Andrea Trombetta ◽  
Maria Rita Lucia Genovese ◽  
Giulia Gortani ◽  
Egidio Barbi
Keyword(s):  
White Cell Count ◽  
Gastrointestinal Symptoms ◽  
Supportive Therapy ◽  
List Type ◽  
X Rays ◽  
Sports Activity ◽  
Reactive Protein ◽  
Lymphatic Circulation ◽  
History Of ◽  
Patient’S History

A 14-year-old girl was admitted to our institute with a history of intermittent bilateral ankle swelling, and moderate but progressively worsening pain which has lasted for 2 years.The patient’s history was unremarkable. She did not take medications and was not involved in any sports activity. She reported no fever, gastrointestinal symptoms, fatigue, weight loss, travels abroad or previous infections. She reported moderate pain at night, associated with a sense of heaviness, tightness and general discomfort, and with no response to ibuprofen.Physical examination was remarkable only for bilateral ankle non-pitting oedema, more evident on the left leg, with a thickened skinfold at the base of the second toe, and without redness, swelling or skin warming.The patient had been previously examined, and her foot and ankle X-rays, ultrasound (US) and MRI were all negative. Blood tests (white cell count, C reactive protein, erythrocyte sedimentation rate, albumin, antinuclear antibodies, creatinine, transaminase, creatine kinase, lactate dehydrogenase, thyroid function and glucose) and urinalysis were in the normal range. Her ocular assessment and echocardiogram were also normal.Question 1Based on the clinical picture and laboratory tests, what is the most likely diagnosis?Deep venous thrombosis.Osteochondritis.Lymphoedema.Juvenile idiopathic arthritis.Question 2Based on what you see in figure 1, what is the underlying cause?Recurrent bacterial lymphangitis.Primary lymphoedema.Tumour.Filariasis.Figure 1Lymphoscintigraphy of the lower extremities showing insufficient deep lymphatic circulation in the left leg (red arrow, A) replaced by superficial drainage (B).Question 3Which is the best diagnostic test to confirm the diagnosis?US scan.MRI.Lymphoscintigraphy.Reassurance and clinical follow-up.Question 4What is the mainstay of management of this condition?Wait and see.Antibiotic course.Supportive therapy (ie, physical activity, elevation of extremities, pneumatic compression).Surgical intervention.Answers can be found on page 2.

929 Not Another Abscess - A Case of Streptococcal Myositis Misdiagnosed as a Right Axillary Abscess

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Oyende ◽  
J Jackman
Keyword(s):  
White Cell Count ◽  
General Surgeon ◽  
High Dose ◽  
General Anaesthetic ◽  
Microbiological Analysis ◽  
Reactive Protein ◽  
Affected Tissue ◽  
Life Threatening ◽  
History Of ◽  
High Degree

Abstract Introduction Streptococcal myositis is a rare form of infectious myositis caused by Lansfield A beta-haemolytic streptococci. It is characterised by rapidly spreading inflammation that can result in severe systemic toxicity and necrosis of the affected tissue if not diagnosed and aggressively treated. Presentation We report a case of a 42-year-old male who presented with a one-week history of worsening right axillary swelling that progressed to painful swelling of his arm. Inflammatory markers were significantly elevated with a white cell count of 17 ×109/L and C-reactive protein of 212 mg/L. On examination, a fluctuant axillary swelling was appreciated, and a decision was made for incision and drainage under general anaesthetic. Intraoperative aspiration of his arm revealed copious purulent fluid prompting intraoperative orthopaedic consult and exploration of the anterior compartment in which there was extensive involvement of the biceps muscle. The microbiological analysis revealed gram-positive cocci in chains, and microbiology advice sought for tailoring of antibiotic regimen. He has recovered well. Discussion Though uncommon, the emergency general surgeon should have a high degree of suspicion when evaluating soft tissue infections to avert potentially disastrous outcomes. Conclusion Early diagnosis, aggressive management with high-dose intravenous antibiotics, and surgical debridement are principles to treat this rare, life-threatening infection.

scholarly journals Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study

Diabetologia ◽  
2021 ◽  
Vol 64 (4) ◽  
pp. 778-794 ◽  
Author(s):  
Matthieu Wargny ◽  
◽  
Louis Potier ◽  
Pierre Gourdy ◽  
Matthieu Pichelin ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Hospital Discharge ◽  
Microvascular Complications ◽  
White Cell Count ◽  
Symptom Duration ◽  
Protein Levels ◽  
Reactive Protein ◽  
Patients With Diabetes ◽  
History Of ◽  
Routine Therapy

Abstract Aims/hypothesis This is an update of the results from the previous report of the CORONADO (Coronavirus SARS-CoV-2 and Diabetes Outcomes) study, which aims to describe the outcomes and prognostic factors in patients with diabetes hospitalised for coronavirus disease-2019 (COVID-19). Methods The CORONADO initiative is a French nationwide multicentre study of patients with diabetes hospitalised for COVID-19 with a 28-day follow-up. The patients were screened after hospital admission from 10 March to 10 April 2020. We mainly focused on hospital discharge and death within 28 days. Results We included 2796 participants: 63.7% men, mean age 69.7 ± 13.2 years, median BMI (25th–75th percentile) 28.4 (25.0–32.4) kg/m2. Microvascular and macrovascular diabetic complications were found in 44.2% and 38.6% of participants, respectively. Within 28 days, 1404 (50.2%; 95% CI 48.3%, 52.1%) were discharged from hospital with a median duration of hospital stay of 9 (5–14) days, while 577 participants died (20.6%; 95% CI 19.2%, 22.2%). In multivariable models, younger age, routine metformin therapy and longer symptom duration on admission were positively associated with discharge. History of microvascular complications, anticoagulant routine therapy, dyspnoea on admission, and higher aspartate aminotransferase, white cell count and C-reactive protein levels were associated with a reduced chance of discharge. Factors associated with death within 28 days mirrored those associated with discharge, and also included routine treatment by insulin and statin as deleterious factors. Conclusions/interpretation In patients with diabetes hospitalised for COVID-19, we established prognostic factors for hospital discharge and death that could help clinicians in this pandemic period. Trial registration Clinicaltrials.gov identifier: NCT04324736 Graphical abstract

Twenty-three year-old with pleuritic chest pain

Heart ◽  
2018 ◽  
Vol 105 (6) ◽  
pp. 464-469
Author(s):  
Karina P Gopaul ◽  
Helen M Parry ◽  
Damien Cullington
Keyword(s):  
Chest Pain ◽  
Congenital Heart ◽  
White Cell Count ◽  
Coarctation Of The Aorta ◽  
List Type ◽  
Pleuritic Chest Pain ◽  
Reactive Protein ◽  
Pulmonary Angiogram ◽  
Night Sweats ◽  
Ct Pulmonary Angiogram

Clinical introductionA 23-year-old woman followed at another medical centre for congenital heart disease (CHD) presented to our emergency clinic with 3 weeks of bilateral pleuritic chest pain. She returned from holiday in Greece 6 weeks earlier where a tattoo and nasal piercing had been performed. There was no history of night sweats or fever.Her temperature was 37.5°C, heart rate 120 beats/min, oxygen saturations 94% on room air and blood pressure 110/74. Her chest was clear and there was systolic murmur on auscultation. The chest radiograph showed peripheral bilateral lower zone atelectasis. The ECG demonstrated sinus tachycardia. The haemoglobin was 11.2 g/dL, white cell count 10.18×109/L, C-reactive protein 67 mg/L (normal <5 mg/L) and D dimer=430 ng/mL (normal <230 ng/mL).A pulmonary embolus was suspected and a CT pulmonary angiogram was performed (figure 1).QuestionBased on the CT findings, what is the most likely underlying congenital heart lesion in this patient?Bicuspid aortic valveCoarctation of the aortaFontan circulationParachute mitral valveVentricular septal defectFigure 1CT pulmonary angiogram (coronal views).

scholarly journals Chondrosternal Arthritis in Infant: An Unusual Entity

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Athina Nikolarakou ◽  
Dana Dumitriu ◽  
Pierre-Louis Docquier
Keyword(s):  
Clinical Symptoms ◽  
Therapeutic Option ◽  
White Blood Cells ◽  
Laboratory Data ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
History Of ◽  
Local Tenderness ◽  
Wait And See

Primary arthritis of chondrosternal joint is very rare and occurs in infants less than 18 months of age. Presentation is most often subacute but may be acute. Child presents with a parasternal mass with history of fever and/or local signs of infection. Clinical symptoms vary from a painless noninflammatory to a painful mass with local tenderness and swelling, while fever may be absent. Laboratory data show low or marginally raised levels of white blood cells and C-reactive protein, reflecting, respectively, the subacute or acute character of the infection. It is a self-limiting affection due to the adequate immune response of the patient. Evolution is generally good without antibiotherapy with a progressive spontaneous healing. A wait-and-see approach with close follow-up in the first weeks is the best therapeutic option.

scholarly journals A case report and literature review: post-traumatic mammary myofibroblastoma

2019 ◽  
Vol 6 (4) ◽  
pp. 1385 ◽  
Author(s):  
Hadi Abdullah Alaskar ◽  
Ahmed Mohammed AlMuhsin ◽  
Mirza Faraz Saeed ◽  
Amro Salem
Keyword(s):  
Case Report ◽  
Malignant Tumors ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Clinical Findings ◽  
Histopathological Analysis ◽  
Minor Trauma ◽  
Elderly Age ◽  
Rare Benign Tumor ◽  
A Minor

Mammary myofibroblastoma is a rare benign tumor of the breast, with a higher incidence in elderly age group. It is diagnosed via radiologic and histologic findings, as clinical findings share the same presentation with other, more common, benign breast pathologies. Surgical excision is the only treatment modality used to treat this tumor. We report the case of a 56-years-old-male, who presented with the complaint of left-sided chest swelling for 1 year following a minor trauma to the chest. Ultrasonographic imaging of the mass was the initial investigation and it revealed a well-defined hypoechoic lesion, excisional biopsy was done, followed by histopathological analysis of the mass, which gave the diagnosis of mammary myofibroblastoma. The aim of this case-report is to further study and characterize this rare lesion and its relationship to previous minor or major trauma and other risk factors, in addition, a proper diagnosis should be taken when encountering a similar mass as it mimics many benign and malignant tumors, furthermore a follow up plan should be established to assess the rate of possible recurrence.

scholarly journals The preliminary comparative results between Covid-19 and non-Covid-19 patients in Western China

2020 ◽  
Author(s):  
Li Yanzi ◽  
Li Hongxia ◽  
Han Jianfeng ◽  
Yang Lin
Keyword(s):  
Clinical Characteristics ◽  
White Cell Count ◽  
Western China ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Sputum Production ◽  
Familial Clustering ◽  
History Of ◽  
Comparative Results ◽  
Major Adverse Events

Abstract Background: This study aims to investigate the comparative clinical characteristics of Covid-19 and non-Covid-19 patients.Methods: Fifteen Covid-19 and 93 non-Covid-19 patients were included in RNA testing. All epidemiological and clinical data were collected and analyzed, and then comparative results were carried out.Results: Covid-19 patients were older (46.40±18.21 years vs 34.43±18.80 years) and hada higher body weight (70.27±10.67 kg vs 60.54±12.33 kg, P<0.05). The main symptoms that were similar between Covid-19 and non-Covid-19 patients, and Covid-19 patients showed a lower incidence of sputum production (6.67% vs 45.16%, P<0.01) and a lower white-cell count (4.83×109/L vs 7.43×109/L) and lymphocyte count (0.90×109/L vs 1.57×109/L) (P<0.01). Although there were no differences, C-reactive protein and interleukin-6 were elevated in Covid-19 patients. The sensitivity and negative predictive value of CT images were 0.87 and 0.97, respectively. Covid-19 patients showed a higher contact history of Wuhan residents (80% vs 30.11%) and higher familial clustering (53.33% vs 8.60%, P<0.001). Covid-19 patients showed a higher major adverse events (ARDS, 13.33%; death, 6.67%; P<0.05).Conclusion: Our results suggested that Covid-19 patients had a significant history of exposure and familial clustering and a higher rate of severe status; biochemical indicators showed lymphocyte depletion.

scholarly journals Which comes first in the double object construction?

2015 ◽  
Vol 19 (2) ◽  
pp. 247-268 ◽  
Author(s):  
NURIA YÁÑEZ-BOUZA ◽  
DAVID DENISON
Keyword(s):  
Direct Object ◽  
List Type ◽  
Type Number ◽  
Double Object ◽  
Dialectal Variation ◽  
Indirect Object ◽  
Dative Alternation ◽  
History Of ◽  
A Minor ◽  
Late Modern

Competition between two methods of marking recipient/beneficiary and theme has figured in much recent research:(1)Jim gave the driver £5.   (indirect object before direct object)(2)Jim gave £5 to the driver.   (direct object before prepositional phrase)A reverse double object variant is often ignored or treated as a minor and highly restricted variant:(3)(a)?Jim gave £5 the driver.   (direct object before indirect object)(b)Jim gave it him.However, pattern (3) was much more widespread even in late Modern English, while there is clear dialectal variation within present-day British English.In this article we investigate the pronominal pattern (3b), mainly in relation to pattern (1), tracking its progressive restriction in distribution. We mine three of the Penn parsed corpora for the general history in English of double object patterns with two pronoun objects. We then add a further nine dialect and/or historical English corpora selected for coverage and representativeness. A usage database of examples in these corpora allows more detailed description than has been possible hitherto. The analysis focuses on verb lemmas, objects and dialect variation and offers an important corrective to the bulk of research on the so-called Dative Alternation between patterns (1) and (2). We also examine works in the normative grammatical tradition, producing a precept database that reveals the changing status of variants as dialectal or preferred. In our conclusion we show the importance of prefabricated expressions (prefabs) in the later history of (3), sketching an analysis in Construction Grammar terms.

Six-year-old boy with a slow-onset persistent back pain

2019 ◽  
pp. edpract-2018-316648
Author(s):  
Giulia Caddeo ◽  
Paola Paganin ◽  
Giulia Gortani ◽  
Marco Carbone ◽  
Massimo Gregori ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Ct Scan ◽  
Spinous Process ◽  
Posterior Arch ◽  
List Type ◽  
Low Back ◽  
Reactive Protein ◽  
Nocturnal Pain ◽  
History Of

A 6-year-old boy was evaluated for a 6-week history of low back pain. Initially, the pain was exacerbated by movements, eventually showing a milder and fluctuating trend. History was unremarkable for previous traumatic events, fever or nocturnal pain. Physical examination revealed localised pain at palpation of the spinous processes at the lumbosacral level. Blood tests showed a normal blood count, negative C reactive protein (CRP) and erythrocyte sedimentation rate, normal lactic acid dehydrogenase (LDH) and creatine phosphokinase.A posterior–anterior radiograph of the lumbar spine resulted normal. An MRI scan revealed a lumbosacral transitional vertebra with bone oedema of the posterior arch until the spinous process.For better bone definition, a CT scan was performed (figure 1).Figure 1CT scan of the transitional lumbosacral (L5) vertebra.QuestionsWhich causes of persistent low back pain should be ruled out in children under 10 years of age?OsteochondrosisNeoplasmFunctional painInfectionsWhat is the diagnosis in this patient?How is the diagnosis performed?How is this condition managed?Answers can be found on page 2.

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