scholarly journals Unusual presentation of acute pancreatitis following high tibial osteotomy

2019 ◽  
Vol 12 (2) ◽  
pp. e227438
Author(s):  
Adam O’Connor ◽  
Peter Asaad
Keyword(s):  
High Tibial Osteotomy ◽  
White Cell Count ◽  
Taxi Driver ◽  
Tibial Osteotomy ◽  
Close Monitoring ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
First Case ◽  
Intravenous Antibiotics ◽  
Glasgow Score

We report a case of a 55-year-old man taxi driver admitted electively for high tibial osteotomy for relief of bilateral medial compartment osteoarthritis. He was obese and an ex-smoker but medical history was otherwise unremarkable. Day 1 postoperatively the patient started to suffer vomiting episodes and the abdomen was distended. C Reactive protein and white cell count were both elevated but other bloods were normal. CT abdomen and pelvis was performed which showed acute interstitial pancreatitis. Glasgow score was calculated as 2. He was treated aggressively with analgesia, intravenous fluid and intravenous antibiotics. He has made a good recovery following these conservative measures. To our knowledge, this is the first case in the literature reporting pancreatitis as a complication of high tibial osteotomy. This case highlights the importance of close monitoring for abdominal complications even in the setting of elective orthopaedic surgery where it is a rare phenomenon.

Rare case of extensive streptococcal myositis

2020 ◽  
Vol 13 (8) ◽  
pp. e235400
Author(s):  
Weh Kiat Gan
Keyword(s):  
Elbow Joint ◽  
Blood Test ◽  
Rare Case ◽  
White Cell Count ◽  
Pectoralis Major Muscle ◽  
Oral Antibiotics ◽  
Good Recovery ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Intravenous Antibiotics

A rare case of extensive streptococcal myositis is reported. A 46-year-old man was admitted following acute swollen right elbow joint associated with localised pain, erythema and hypoaesthesia. Multiple tense blisters subsequently developed around the affected elbow joint extending to the axilla. He was treated for suspected soft tissue infection and septic arthritis. Blood test investigations demonstrated raised creatine kinase (894 U/L) and inflammatory markers (white cell count 21.1×109/L; C reactive protein 370 mg/L). Emergency CT scan reported extensive myositis affecting the triceps, latissimus dorsi and pectoralis major muscle with no fascial involvement. He was escalated to intensive care unit and treated for infectious myositis. Further investigation revealed positive streptococcal antibody (anti-streptodornase B titre >1600 U/mL). He was managed conservatively with microbiologist specialist input and supportive care. The patient made good recovery after receiving 10 days of intravenous antibiotics and subsequently switched to oral antibiotics. He was discharged on day 30 of admission after receiving intensive inpatient physiotherapy.

Neonatal Toxic Shock Syndrome–Like Exanthematous Disease in North America

2019 ◽  
Author(s):  
Megan Culler Freeman ◽  
Stephanie Mitchell ◽  
John Ibrahim ◽  
John V Williams
Keyword(s):  
North America ◽  
Diagnostic Criteria ◽  
Skin Rash ◽  
Toxic Shock Syndrome ◽  
Disease Process ◽  
Toxic Shock ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
First Case

Abstract Neonatal toxic shock syndrome (TSS)-like exanthematous disease (NTED) is a syndrome first reported in Japan. Neonates develop systemic exanthema, thrombocytopenia, and fever usually during the first week of life. The disease is distinguished from frank TSS because affected infants are not severely ill and do not meet TSS criteria. Most infants are confirmed to be colonized with TSST-1 producing strains of S. aureus. Suggested diagnostic criteria for NTED include a skin rash with generalized macular erythema and one of the following symptoms: fever >38.0°C, thrombocytopenia <150 x103uL, or low positive C-reactive protein (1-5 mg/dL) in the absence of another known disease process. NTED is common in Japanese NICUs, but outside Japan, only one case has been reported in France. We describe the first case of NTED reported in North America.

scholarly journals The diagnostic value of white cell count, C-reactive protein and bilirubin in acute appendicitis and its complications

2013 ◽  
Vol 95 (3) ◽  
pp. 215-221 ◽  
Author(s):  
I G Panagiotopoulou ◽  
D Parashar ◽  
R Lin ◽  
S Antonowicz ◽  
AD Wells ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Cell Count ◽  
Inflammatory Markers ◽  
White Cell Count ◽  
Perforated Appendicitis ◽  
Diagnostic Value ◽  
White Cell ◽  
C Reactive Protein ◽  
Reactive Protein

Introduction Inflammatory markers such as white cell count (WCC) and C-reactive protein (CRP) and, more recently, bilirubin have been used as adjuncts in the diagnosis of appendicitis. The aim of this study was to determine the diagnostic accuracy of the above markers in acute and perforated appendicitis as well as their value in excluding the condition. Methods A retrospective analysis of 1,169 appendicectomies was performed. Patients were grouped according to histological examination of appendicectomy specimens (normal appendix = NA, acute appendicitis = AA, perforated appendicitis = PA) and preoperative laboratory test results were correlated. Receiver operating characteristic (ROC) curve area analysis (area under the curve [AUC]) was performed to examine diagnostic accuracy. Results ROC analysis of all laboratory variables showed that no independent variable was diagnostic for AA. Good diagnostic accuracy was seen for AA when all variables were combined (WCC/CRP/bilirubin combined AUC: 0.8173). In PA, the median CRP level was significantly higher than that of AA (158mg/l vs 30mg, p<0.0001). CRP also showed the highest sensitivity (100%) and negative predictive value (100%) for PA. CRP had the highest diagnostic accuracy in PA (AUC: 0.9322) and this was increased when it was combined with WCC (AUC: 0.9388). Bilirubin added no diagnostic value in PA. Normal levels of WCC, CRP and bilirubin could not rule out appendicitis. Conclusions CRP provides the highest diagnostic accuracy for PA. Bilirubin did not provide any discriminatory value for AA and its complications. Normal inflammatory markers cannot exclude appendicitis, which remains a clinical diagnosis.

scholarly journals Serum C - Reactive Protein, White Cell Counts and Neutrophil Percentage are Predictors For Distal Ureteric Calculus Expulsion Rate: A Prospective Study

2019 ◽  
Vol 8 (1) ◽  
pp. 58-62
Author(s):  
Ram Sagar Shah ◽  
Kaushal Sigdel
Keyword(s):  
Cell Count ◽  
White Cell Count ◽  
White Cell ◽  
C Reactive Protein ◽  
Expulsion Rate ◽  
Reactive Protein ◽  
Ureteric Calculus ◽  
Cell Counts ◽  
Neutrophil Percentage ◽  
Wbc Count

Background: To determine the relationship between expulsion rate of distal ureteric calculus less than orequal to 10mm in size and C reactive protein (CRP) level, white cell count and neutrophil percentage. Materials and Methods: A total of 186 patients with distal ureteric calculus of ≤10mm were evaluated for stone expulsion rate and its correlation with serum CRP, white cell count and neutrophil percentage. All patients received tablet Tamsulosin 0.4mg for 4 weeks or till the expulsion of stone. Patients were called weekly till 4 weeks, or early if there was history of stone expulsion. Patients were divided in two groups according to normal and elevated CRP levels, white cell count and neutrophil percent age at baseline for statistical analysis. Results: The patients had an average age of 35.6 } 13.9 years. 52.2% were male. Ratio of right to left was1.58:1. Majority of the patients with distal ureteric calculus ≤ 10mm passed their stone (74.7 %) with medical expulsion therapy. Expulsion of stone less than 5mm was statistically significant (p0.017). Patients with normal neutrophil percentage and normal CRP level had higher stone expulsion rate than elevated neutrophil or CRP (85.2% vs. 40.9, 91.8% vs. 30.8% respectively).In patients with normal white cell count, 86.4% passed their stone while in elevated white cellcount group 39.1% passed their stone. Conclusion: This study showed patients with distal ureteric calculus of ≤10mmwith normal CRP level and normal neutrophil count had higher expulsion rate while WBC count showed no statistically significant association.

scholarly journals Response patterns of routinely measured inflammatory and coagulatory parameters in sepsis

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e7147
Author(s):  
Mirjam Bachler ◽  
Tobias Hell ◽  
Lukas Schausberger ◽  
Christine Schlömmer ◽  
Volker Schäfer ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Proportional Hazards ◽  
Peak Level ◽  
Patient Characteristics ◽  
Cox Proportional Hazards ◽  
Close Monitoring ◽  
Response Patterns ◽  
C Reactive Protein ◽  
Disease Etiology ◽  
Reactive Protein

BackgroundSepsis is characterized by a pro-inflammatory and pro-coagulatory shift which can induce life-threatening complications. Close monitoring and risk stratification of sepsis patients is crucial for proper treatment and consequently patient outcome. Therefore, this study focuses on the response patterns of inflammatory and coagulatory parameters used in clinical routines to estimate the course of sepsis.MethodsA total of 1,110 patients diagnosed with sepsis were retrospectively analyzed to identify response patterns for risk stratification of routine parameters measured at the peak level of C-reactive protein. Cluster analysis was used and the differences in the patient characteristics and 28-day survival were assessed. Cox proportional hazards regression model for survival stratified by the clusters was performed.ResultsThe analyses revealed the parameters to have five distinct response patterns. These clusters reflect the etiology as well as the course of sepsis associated with different mortalities. Here, impairment of the liver plays a crucial role in the ability to appropriately respond to sepsis. Of the routinely measured parameters, C-reactive protein and antithrombin seem to be unspecific for stratification of septic patients. Adjusted for the individual clusters, survival was associated with an increase in fibrinogen (p = 0.0042), platelets (p = 0.0003) and PT (p = 0.001) as well as a decrease in leukocytes (p = 0.034).ConclusionsThis study reveals that patients have distinct response patterns of inflammatory and coagulatory parameters depending on disease etiology. These patterns are associated with different mortalities although the patients have similar levels of C-reactive protein. Independently of the type of response, good coagulatory capacity seems to be crucial for patient survival.

scholarly journals EP.FRI.1040 Management of Acute Colonic Diverticulitis According to The WSES (World Society of Emergency Surgery) Classification in a Tertiary Centre

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Lorraine Hickey ◽  
Paul Goldsmith
Keyword(s):  
Acute Diverticulitis ◽  
White Cell Count ◽  
Colonic Diverticulitis ◽  
C Reactive Protein ◽  
Single Centre ◽  
Ct Guided ◽  
Reactive Protein ◽  
Tertiary Centre ◽  
Acute Colonic Diverticulitis

Abstract Aims Debate remains regarding management of complicated diverticulitis. The WSES acute diverticulitis working group published in 2015 a CT-guided classification of left colon acute diverticulitis, divided into uncomplicated (Stage 0) and complicated (Stage 1a-4). Using this classification, we reviewed our management of CT-proven acute colonic diverticulitis. Methods A single-centre retrospective review of management of CT-proven acute colonic diverticulitis over 12 months based on the WSES classification. Results 24 males and 31 females presented (median age=56, IQR 45-68). Median white cell count=12 (IQR 10-16) and median C-reactive protein=88 (IQR 41-157). Based on CT, 25 (45.5%) patients =stage 0, 14 (25.5%) =stage 1a, 6 (11%) =stage 1b, 4 (7%) =stage 2a, 6 (11%) =stage 2b, and none staged 3/4. 15% (8/55) patients had an operation, remainder were conservatively managed. 2 patients had laparoscopic washout/drainage (stages 1b and 2b). 6 patients had Hartmanns (x1 stage 1a, x1 stage 1b, x4 stage 2b).  Median length of stay=5 days (IQR 4-8). There was 1 related reattendance declining readmission (stage 1a managed conservatively) and 2 readmissions (1 stage 0 managed conservatively, other initially stage 1a managed conservatively but on readmission staged 2b proceeding to Hartmanns). 30-day mortality included 3 deaths (stages 1b/2a/2b all managed conservatively). Conclusions Hartmanns resection is advocated as treatment of choice for complicated acute diverticulitis, particularly for Stage 2b or above.

scholarly journals Mid-regional proadrenomedullin (MR-proADM), C-reactive protein (CRP) and other biomarkers in the early identification of disease progression in patients with COVID-19 in the acute NHS setting

2022 ◽  
pp. jclinpath-2021-207750
Author(s):  
Nathan Moore ◽  
Rebecca Williams ◽  
Matilde Mori ◽  
Beatrice Bertolusso ◽  
Gabrielle Vernet ◽  
...  
Keyword(s):  
Critical Care ◽  
Disease Progression ◽  
Cox Regression ◽  
White Cell Count ◽  
Tertiary Care ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Non Invasive Ventilation ◽  
Increased Risk ◽  
Critical Care Admission

AimsThere is a lack of biomarkers validated for assessing clinical deterioration in patients with COVID-19 on presentation to secondary or tertiary care. This evaluation looked at the potential clinical application of C reactive protein (CRP), procalcitonin, mid-regional proadrenomedullin (MR-proADM) and white cell count to support prediction of clinical outcomes.Methods135 patients presenting to Hampshire Hospitals NHS Foundation Trust between April and June 2020 confirmed to have COVID-19 via reverse-transcription-qPCR were included. Biomarkers from within 24 hours of presentation were used to predict disease progression by Cox regression and area under the receiver operating characteristic curves. The endpoints assessed were 30-day all-cause mortality, intubation and ventilation, critical care admission and non-invasive ventilation (NIV) use.ResultsElevated MR-proADM was shown to have the greatest ability to predict 30-day mortality adjusting for age, cardiovascular disease, renal disease and neurological disease. A significant association was also noted between raised MR-proADM and CRP concentrations and the requirement for critical care admission and NIV.ConclusionsThe measurement of MR-proADM and CRP in patients with confirmed COVID-19 infection on admission shows significant potential to support clinicians in identifying those at increased risk of disease progression and need for higher level care, subsequently enabling prompt escalation in clinical interventions.

scholarly journals Pyomyositis of the pectineus muscle in an adolescent male

2017 ◽  
Vol 99 (7) ◽  
pp. e216-e218 ◽  
Author(s):  
J Hiddema ◽  
S Hassan ◽  
N Mangat ◽  
N Siddiqui
Keyword(s):  
White Cell Count ◽  
Normal Function ◽  
Adolescent Male ◽  
Reactive Protein ◽  
Intravenous Antibiotics ◽  
Tropical Areas ◽  
Widespread Availability ◽  
Magnetic Resonance Imaging Mri ◽  
Irritable Hip

The ‘irritable hip’ continues to pose a challenge for clinicians. Even with predictive clinical algorithms, decision making can be difficult. Emergency treatment is required if septic arthritis is suspected. Other differential diagnoses such as transient synovitis, pyomyositis of the pelvic girdle muscles and osteomyelitis must be considered in order to help guide appropriate investigations and allow early treatment. We report the case of a 13-year-old boy presenting to our institution with an acutely painful left hip but still able to weight bear. Despite a fever and raised inflammatory markers, the clinical examination did not correspond to that of an infected hip joint. Urgent magnetic resonance imaging (MRI) confirmed pyomyositis of the pectineus muscle. To our knowledge, this is the first reported case in the literature. The child was treated with seven days of intravenous antibiotics. There was a good clinical response as well as normalisation of the C-reactive protein level and white cell count. The patient was discharged home with a further week of oral antibiotics. Follow-up MRI at two weeks demonstrated a dramatic reduction in the inflammation of the pectineus. At the clinic follow-up appointment, the child was asymptomatic and back to normal function. Pyomyositis is typically found in tropical areas but its rates in temperate climates have been rising. It usually affects large groups of muscles such as the quadriceps and gluteal muscles. MRI is the gold standard investigation. If diagnosed early, the condition can be treated successfully with intravenous antibiotics alone. Given the widespread availability of MRI, we recommend its increased use to distinguish between pyomyositis and other paediatric hip pathologies.

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