scholarly journals Extraosseous Ewing sarcoma presenting as recurrent intergluteal pilonidal disease

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Marisa A. Sewell ◽  
Frieda M. Hulka ◽  
Jacob P. Zucker
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Ewing Sarcoma ◽  
Pilonidal Disease ◽  
Treatment Options ◽  
Incision And Drainage ◽  
Soft Tissue Swelling ◽  
History Of ◽  
Pilonidal Abscess ◽  
Extraosseous Ewing Sarcoma

Abstract Background Pilonidal disease classically presents as an abscess or soft tissue swelling which classically occurs in the intergluteal cleft, just above the anus. Risk factors for this disease include obesity, prolonged sitting, and abundance of gluteal hair. Treatment options are extensive but most often include incision and drainage with antibiotic treatment. Presentation of recurrent intergluteal pilonidal disease in a young, active female would then be unusual. We present a case of a 17-year-old female presenting with what appeared to be intergluteal pilonidal disease. Definitive excision with histopathology revealed a diagnosis of extraosseous Ewing sarcoma. Case presentation An otherwise healthy and active 17-year-old female presented to our Pediatric Oncology clinic with a 2-month history of recurrent painful soft tissue swelling of the intergluteal cleft. At that time, she had been diagnosed with pilonidal abscess and had already undergone three incision and drainage procedures. A definitive excision with pathology was performed within weeks of her initial presentation. Immunohistochemical evaluation confirmed a diagnosis of extraosseous Ewing sarcoma. Conclusion This unusual case underlies the importance of considering a broad differential when evaluating potential pilonidal abscess in a patient who otherwise has no risk factors. Additionally, definitive excision with pathology is critical in a patient with unusually recurrent disease as this can be crucial in the identification of an alternative, and potentially devastating, diagnosis.

Stress Fractures in Royal Marine Recruits

1970 ◽  
Vol 56 (1) ◽  
pp. 78-91
Author(s):  
J. Bertram
Keyword(s):  
Soft Tissue ◽  
Weight Bearing ◽  
Fracture Site ◽  
Stress Fractures ◽  
Vigorous Activity ◽  
Main Symptom ◽  
Soft Tissue Swelling ◽  
History Of ◽  
Radiological Changes

AbstractThe main features of stress fractures in Royal Marine recruits are that they occur in normal bones, most often those that are weight bearing. There is no history of injury, but there is usually a history of unaccustomed or more vigorous activity for some weeks before onset. The main symptom is pain on use of the affected part and this pain is relieved by rest. Localised tenderness and soft tissue swelling are present at the fracture site when the affected bone is readily palpable. Radiological changes are absent in the first seven to ten days, but become visible within two months, unless treatment starts or stress ceases early.

scholarly journals Septic arthritis is a mimicker of rheumatic fever

Mediscope ◽  
2018 ◽  
Vol 6 (1) ◽  
pp. 41-43
Author(s):  
KZ Hossain ◽  
MN Islam
Keyword(s):  
Soft Tissue ◽  
Physical Examination ◽  
Septic Arthritis ◽  
Acute Inflammation ◽  
Plain Radiograph ◽  
Knee Joints ◽  
Fluid Accumulation ◽  
Laboratory Findings ◽  
Soft Tissue Swelling ◽  
History Of

Septic arthritis is an uncommon form of arthritis in children. A five years old boy presented with pain and swelling of both knee joints for 7 days. His joints swellings were disproportionate to pain. He had no history of trauma to the joints. On examination, there was soft tissue swelling of both knee joints. Investigation showed features of acute inflammation. Plain radiograph showed soft tissue swelling. Ultrasonography showed fluid accumulation in joints space. After 7 days of antistaphylococcal therapy, the child improved significantly. Physicians treating the children need to be aware of taking proper history and doing physical examination and checking laboratory findings of the children with septic arthritis for appropriate case management. Mediscope Vol. 6, No. 1: Jan 2019, Page 41-43

Effectiveness of tablet family history collection in a multidisciplinary pancreatic tumor clinic in identifying patients with risk factors for hereditary cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13020-e13020
Author(s):  
Jessica Everett ◽  
Kara Schradle ◽  
Heather Cameron ◽  
Anisha Patel ◽  
Erika Koeppe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Pancreatic Tumor ◽  
Treatment Options ◽  
Cancer History ◽  
Referral Criteria ◽  
Counseling And Testing ◽  
Standard Family ◽  
Family Cancer History ◽  
History Of

e13020 Background: A substantial percentage of patients with pancreatic adenocarcinoma (PDAC) harbor pathogenic germline variants in known cancer risk genes, some with relevance for treatment options. Robust collection of relevant personal and family cancer history risk factors for all patients with PDAC is needed to optimize identification of those who could benefit from genetic counseling and testing (GC/GT). Methods: 464 adult patients (≥18 years of age) presenting to a multi-disciplinary pancreatic tumor clinic were invited to complete a tablet based family cancer history survey prior to their clinic appointments. Standard family history entry into electronic medical record (EMR) was reviewed for comparison. Eight GC/CT referral criteria were developed based on existing guidelines for known syndromes associated with PDAC, reported findings from studies of GC/GT outcomes in patients with PDAC, and expert opinion. Presence of any of the 8 criteria were documented for both tablet and EMR collection methods in the subset of patients with PDAC (n = 230). Results: Completion rate for the tablet survey was high (87%). 78% of users completed the survey in ≤15 minutes (x̄ = 12 minutes). 202 patients with PDAC (88%) completed the tablet survey, and 100 (50%) met ≥1 GC/GT criteria. Most frequent criteria identified were: ≥2 relatives with related cancers (28%); ≥1 relative with PDAC (12.9%); personal history of related cancer (12.9%). Tablet data collection improved identification of relatives with breast cancer ca < age 50 from 1.5% to 5.5% due to missing ages at diagnosis in the EMR. The tablet survey also identified 12 patients with Ashkenazi Jewish (AJ) ancestry (6%), a risk factor not accounted for in EMR. Conclusions: Tablet based family cancer history collection is well accepted by patients and easily integrated into clinic work flow. The tablet survey found GC/GT criteria in 50%, and improved identification of key risk factors for BRCA1/2 mutation (AJ ancestry, relative with breast ca < age 50). Further work should focus on integration of tablet based survey data into EMR, and decision support tools to optimize referral and follow through with genetic services.

scholarly journals Tumor-Infiltrating B- and T-Cell Repertoire in Pancreatic Cancer Associated With Host and Tumor Features

2021 ◽  
Vol 12 ◽  
Author(s):  
Silvia Pineda ◽  
Evangelina López de Maturana ◽  
Katharine Yu ◽  
Akshay Ravoor ◽  
Inés Wood ◽  
...  
Keyword(s):  
Risk Factors ◽  
T Cell ◽  
Treatment Options ◽  
Previous History ◽  
Pancreatic Tissue ◽  
Ductal Adenocarcinoma ◽  
Phenotypic Variance ◽  
Cell Repertoire ◽  
Cdr3 Length ◽  
History Of

BackgroundInfiltrating B and T cells have been observed in several tumor tissues, including pancreatic ductal adenocarcinoma (PDAC). The majority known PDAC risk factors point to a chronic inflammatory process leading to different forms of immunological infiltration. Understanding pancreatic tumor infiltration may lead to improved knowledge of this devastating disease.MethodsWe extracted the immunoglobulins (IGs) and T cell receptors (TCRs) from RNA-sequencing of 144 PDAC from TCGA and 180 pancreatic normal tissue from GTEx. We used Shannon entropy to find differences in IG/TCR diversity. We performed a clonotype analysis considering the IG clone definition (same V and J segments, same CDR3 length, and 90% nucleotide identity between CDR3s) to study differences among the tumor samples. Finally, we performed an association analysis to find host and tumor factors associated with the IG/TCR.ResultsPDAC presented a richer and more diverse IG and TCR infiltration than normal pancreatic tissue. A higher IG infiltration was present in heavy smokers and females and it was associated with better overall survival. In addition, specific IG clonotypes classified samples with better prognosis explaining 24% of the prognosis phenotypic variance. On the other hand, a larger TCR infiltration was present in patients with previous history of diabetes and was associated with lower nonantigen load.ConclusionsOur findings support PDAC subtyping according to its immune repertoire landscape with a potential impact on the understanding of the inflammatory basis of PDAC risk factors as well as the design of treatment options and prognosis monitoring.

Characterizing Husbandry Risk Factors Associated with Metastatic Soft Tissue Mineralization in Zoo-Housed Komodo Dragons (Varanus komodoensis) in the United States

2021 ◽  
Author(s):  
Dawn Zimmerman ◽  
Jennifer H. Yu ◽  
Willem Schaftenaar ◽  
Laura Debnar ◽  
Drury Reavill ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Soft Tissue ◽  
Multinomial Logistic Regression ◽  
The United States ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Significant Difference ◽  
History Of ◽  
Univariate Analyses

Metastatic soft tissue mineralization has emerged as a major cause of death in captive Komodo dragons ( Varanus komodoensis ). A cross-sectional survey-based study was performed to evaluate husbandry-related risk factors for metastatic mineralization in zoo-housed Komodo dragons in the United States. Nineteen institutions participated, nine of which (47.4%) had a history of metastatic mineralization within their collections. Husbandry at participating institutions varied in temperature gradients, outdoor exposure, artificial lighting, and diet items offered. Differences in husbandry were tested between institutions with and without a history of mineralization using univariate analyses, and variables resulting in a significance level ≤0.10 were entered into a multinomial logistic regression model. The only variable demonstrating a significant difference during univariate analyses was the number of dragons per enclosure ( p =0.036), while the only significant predictive variable after modeling was humidity approximation. Zoos that approximated rather than measured humidity were 12.0 times as likely to have a history of mineralization in their Komodo dragons (OR 12.0, p =0.045). These variables likely reflect the under- or overestimation of exhibit humidity levels, and the tendency to house males and females together. Based on post-mortem findings for 27 dragon mortalities from these institutions, the presence of mineralization at necropsy was significantly associated with female dragons (OR 18.2, p =0.0044) and yolk coelomitis or embolism (OR 6.76, p =0.046). Although this study did not identify definitive links between husbandry and the prevalence of mineralization at the institutional level, the survey revealed high variation in husbandry conditions, and potential

Cutaneous Paecilomycosis in a Cat

2003 ◽  
Vol 39 (6) ◽  
pp. 543-546 ◽  
Author(s):  
Edmund J. Rosser
Keyword(s):  
Body Weight ◽  
Soft Tissue ◽  
Bacterial Culture ◽  
Histopathological Examination ◽  
Fungal Culture ◽  
Upper Lip ◽  
Soft Tissue Swelling ◽  
History Of ◽  
Aerobic And Anaerobic ◽  
Surgical Excisions

A cat was presented for a 2-year history of a recurrent, soft-tissue swelling of the left metacarpal region. The mass was excised and submitted for aerobic and anaerobic bacterial culture, fungal culture, and histopathological examination. Cultures revealed the organism Paecilomyces lilacinus, and histopathological examination showed a nodular mycotic granuloma. Itraconazole (10 mg/kg body weight, per os [PO], q 24 hours) was administered and continued for a total of 60 days, with a swelling of the upper lip occurring 3 months after the initial presentation. Subsequent surgical excisions and debridements along with treatment with itraconazole (20 mg/kg body weight, PO, q 24 hours) for a total of 4 months were curative.

Analysis of prevertebral soft-tissue swelling and dysphagia in multilevel anterior cervical discectomy and fusion with recombinant human bone morphogenetic protein–2 in patients at risk for pseudarthrosis

2011 ◽  
Vol 14 (2) ◽  
pp. 244-249 ◽  
Author(s):  
Joseph B. Stachniak ◽  
Jeffrey D. Diebner ◽  
Estee S. Brunk ◽  
Shelley M. Speed
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Neck Disability Index ◽  
Bone Morphogenetic Protein 2 ◽  
Arm Pain ◽  
Pain Scores ◽  
Morphogenetic Protein ◽  
Soft Tissue Swelling ◽  
Human Bone Morphogenetic Protein ◽  
Neck Disability

Object The goal of this study was to demonstrate the incidence of fusion and soft-tissue swelling in multilevel anterior cervical discectomies and fusions (ACDFs) using polyetheretherketone (PEEK) spacers with recombinant human bone morphogenetic protein–2 (rhBMP-2) impregnated in a Type I collagen sponge and titanium plates. Methods A single surgeon performed 30 multilevel ACDFs using PEEK spacers with an rhBMP-2 impregnated collagen sponge (0.4 ml, or the equivalent of 0.6 mg rhBMP-2). Soft-tissue swelling was assessed using cervical spine radiographs on postoperative Day 1 and at 2, 6, and 10 weeks and 6 months after surgery. Incidence of dysphagia was assessed with the Cervical Spine Research Society Swallowing–Quality of Life tool. Clinical success was evaluated with the Neck Disability Index, neck pain scores, and arm pain scores. Final fusion was assessed with CT by an independent neuroradiologist. Results Patients were followed for 6 months unless they had an incomplete fusion; those patients were reassessed at 9 months. Twenty-four patients underwent 2-level ACDFs and 6 underwent 3-level ACDFs were performed on patients with the following risk factors for pseudarthrosis: smoking (33%), diabetes (13%), and obesity (body mass index ≥ 30 [43%]). Seventeen percent of the patients had multiple risk factors. Soft-tissue swelling peaked at 2 weeks regardless of level of surgery or number of levels treated surgically and decreased to near preoperative levels by 6 months. At 2 weeks, Swallowing–Quality of Life evaluation showed 19% of patients frequently choking on food, 4.8% frequently choking when drinking, and 47.6% with frequent food sticking in the throat. Scores continued to improve, and at 6 months, 0% had frequent choking on food, 6.7% had frequent difficulty drinking, and 6.7% had frequent food sticking in the throat. The Neck Disability Index, neck pain, and arm pain scores all improved progressively over 6 months. Incidence of fusion was 95% at 6 months and 100% at 9 months. There were no rehospitalizations or reoperations for soft-tissue swelling or dysphagia. Conclusions Multilevel ACDF procedures using PEEK grafts and rhBMP-2 can be performed safely in patients with multiple risk factors for pseudarthrosis with excellent fusion outcomes.

scholarly journals Fracture prevention: a population-based intervention delivered in primary care

QJM ◽  
2019 ◽  
Vol 113 (5) ◽  
pp. 313-319
Author(s):  
K Hoggard ◽  
S Hart ◽  
J Birchall ◽  
S Kirk ◽  
I Goff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Treatment Options ◽  
Clinical Excellence ◽  
Fracture Prevention ◽  
Population Based ◽  
Osteoporosis Diagnosis ◽  
Nice Guidance ◽  
Risk Patients ◽  
History Of

Abstract Background Osteoporosis is common, increasing as the population ages and has significant consequences including fracture. Effective treatments are available. Aim To support proactive fracture risk assessment (FRAX) and optimizing treatment for high-risk patients in primary care. Design Clinical cohort Setting November 2017 to November 2018, support was provided to 71 practices comprising 69 of 90 practices within two National Health Service Clinical Commissioning Groups areas. Total population 579 508 (207 263 aged over 50 years). Participants FRAX (National Institute for Care and Clinical Excellence, NICE CG146) in (i) males aged 75 years and over, (ii) females aged 65 years and over, (iii) females aged under 65 years and males aged under 75 years with risk factors and (iv) under 50 years with major risk factors. Results A total of 158 946 met NICE CG146, 11 961 were coded with an osteoporosis diagnosis (7.5%), of those, 42% were prescribed treatment with a bone sparing agent (BSA). In total, 6942 were assessed to initiate BSA. Thirty percent of untreated osteoporosis diagnosis patients had never been prescribed BSA. Even when prescribed, 1700 people (35%) were for less than minimum recommended duration. Of the total 9784 patients within the FRAX recommended to treat threshold, 3197 (33%) were currently treated with BSA and 3684 (37%) had no history of ever receiving BSA. From untreated patients, expected incidence of 875 fractures over a 3-year period (approximately £3.4 million). Treatment would prevent 274 fractures (cost reduction: £1 274 045, with prescribing costs: saving £805 145 after 3 years of treatment). Conclusion Underdiagnosis and suboptimal treatment of osteoporosis was identified. Results suggest that implementing NICE guidance and optimizing treatment options in practice is possible and could prevent significant fractures.

scholarly journals Primary Ewing sarcoma of the larynx with distant metastasis: a case report and review of the literature

2019 ◽  
Vol 26 (4) ◽  
Author(s):  
C. A. Maroun ◽  
I. Khalifeh ◽  
A. Tfayli ◽  
R. V. Moukarbel
Keyword(s):  
Computed Tomography ◽  
Vocal Cord ◽  
Ewing Sarcoma ◽  
Present Report ◽  
Thyroid Cartilage ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
History Of ◽  
The Right ◽  
Extraosseous Ewing Sarcoma

Extraosseous Ewing sarcoma is a rare, poorly differentiated round-cell tumour that is part of the Ewing sarcoma family of tumours. Here, we present an extremely rare case of primary extraosseous Ewing sarcoma arising in the larynx, with distant metastases.    A 53-year-old man with a history of Hodgkin lymphoma treated 4 years earlier with 8 cycles of chemotherapy presented to our medical centre with a 2-week history of hoarseness. On physical examination, he was found to have a right supraglottic mass together with a fixed right vocal cord. Computed tomography imaging of the patient’s neck showed a heterogeneously enhancing lesion measuring 5.0×3.8×3.8 cm, centred on the right thyroid cartilage and invading the right true vocal cord. Imaging by integrated fluorodeoxyglucose positron-emission tomography and computed tomography showed active subcarinal and axillary lymph nodes, multiple scattered lung nodules, and multiple bony metastases. Needle core biopsy of the laryngeal mass was diagnostic for Ewing sarcoma. The patient received radiation to the laryngeal area and then alternating cycles of vincristine–actinomycin-D–cyclophosphamide and etoposide–ifosfamide. The patient remains in remission 1 year after completing therapy.    As demonstrated in the present report, these tumours can behave very aggressively both locally and by metastasizing to distant organs. Our treatment approach provided favourable results for the patient; however, future reports are needed to further elucidate optimal management.

scholarly journals Carbapenems for the Treatment of Pneumonia: A literature review regarding resistance, risk factors, and mortality

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Tania R. Amalia ◽  
Eli Halimah ◽  
Riyadi Adrizain ◽  
Miski A. Khairinisa
Keyword(s):  
Risk Factors ◽  
Respiratory Infections ◽  
Treatment Options ◽  
Tertiary Care ◽  
Simplified Acute Physiology Score ◽  
Resistance Risk ◽  
Failure Assessment ◽  
Care Facilities ◽  
Duration Of Hospitalization ◽  
History Of

Carbapenem is one of antibiotic to treat respiratory infections such as pneumonia that frequently used in tertiary care facilities and started to create resistances. This study aims to review the resistance of carbapenems, assess the risk factors for resistance that leads to mortality, and the more effective antibiotic treatment options to overcome the resistance. Assessment of the use of carbapenems in pneumonia through previous studies were carried out by searching the articles in search engine databases in 2011 to 2021. Articles reporting carbapenems resistance, risk factors, and mortality were selected based on inclusion and exclusion criteria. Of 14 articles included in inclusion criteria, 4 studies reported the occurrence of resistance to gram-negative bacteria such as Acinetobacter aumanii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, and 10 articles reported risk factors and mortality. The risk factors for carbapenems resistance are the history of carbapenems use, duration of hospitalization, use of mechanical ventilation, high Simplified Acute Physiology Score (SAPS) scores, and high Acute Physiologic and Chronic Health Evaluation (APACHE). Carbapenems resistance causes mortality such as septic shock, high Sequential Organ Failure Assessment (SOFA) scores, and elevated risk at > 60 years of age, female sex, and inappropriate choice of antibiotics. The results showed that imipenem has higher resistance than other carbapenems members, the risk factors for carbapenems resistance are dominated by a history of carbapenems use, mortality caused by high score SOFA, and colistin can be the current choice to overcome carbapenems resistance.

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