scholarly journals Cutaneous blastomycosis: a clue to a systemic disease

2013 ◽  
Vol 88 (2) ◽  
pp. 287-289 ◽  
Author(s):  
Alex G Ortega-Loayza ◽  
Tuyet Nguyen
Keyword(s):  
Back Pain ◽  
Skin Biopsy ◽  
Ct Scan ◽  
Systemic Disease ◽  
Central Ulceration

A 55-year-old male presented with back pain and slightly tender annular plaques with central ulceration on his face. A skin biopsy revealed scattered yeast with broad based buds. A CT scan of the abdomen revealed a pathologic T12 fracture. Tissue obtained from the spine confirmed budding yeasts. The patient was diagnosed with disseminated blastomycosis. The patient was treated with amphotericin and itraconazole and completely recovered.

Infections of the Aorta: Case Report and Review of Treatment

Vascular ◽  
2005 ◽  
Vol 13 (4) ◽  
pp. 252-256 ◽  
Author(s):  
Shannon Lehner ◽  
Catherine Wittgen
Keyword(s):  
Back Pain ◽  
Case Report ◽  
Ct Scan ◽  
Rapid Development ◽  
Compression Fracture ◽  
Lower Lobe ◽  
Computed Tomographic ◽  
Emergent Operation ◽  
Surgical Options

Radiographic documentation of the rapid development of an aortic infection has not previously been reported. We report the case of a 68-year-old woman who presented with back pain. A computed tomographic(CT) scan documented a nondisplaced L1 compression fracture as well as an atherosclerotic but nonaneurysmal aorta. Two weeks after discharge, she developed left lower lobe pneumonia and was readmitted. A second CT scan was obtained because of continuous complaints of back pain. A contained rupture of the visceral aorta was now clearly visible. Emergent operation successfully repaired her aorta. The microorganisms responsible for aortic infection have changed since the widespread use of antibiotics. Patterns of aortic involvement have also evolved. The difficulty in making these diagnoses, the role of current antibiotic therapy, and the surgical options for these infections will be discussed.

PS01.018: PERSISTENT DYSPHAGIA AFTER FUNDOPLICATION WITH MESH PLASTY –MISSED OR MISTAKEN –A CASE REPORT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 55-55
Author(s):  
Servarayan Chandramohan ◽  
Visvarath Varadharajan ◽  
Madeshwaran Chinnathambi ◽  
Kanagavel Manickavasagam ◽  
Abishai Jebaraj ◽  
...  
Keyword(s):  
Skin Biopsy ◽  
Mesh Repair ◽  
Conflicts Of Interest ◽  
Case Reports ◽  
Systemic Disease ◽  
Transhiatal Esophagectomy ◽  
High Resolution Manometry ◽  
Failed Fundoplication ◽  
Rule Out

Abstract Background Scleroderma esophagus is a rare entity. Only few case reports of esophagectomy were done and reported for this condition. We are presenting this rare case of failed fundoplication and mesh repair with a diagnosis of GERD and hiatus hernia, which was found later on due to Scleroderma with Esophageal involvement. Methods 58 year old female admitted with dysphagia following laproscopic fundoplication with mesh repair of crura with a diagnosis of GERD and hiatus hernia.She presented with persistent vomiting and loss of weight.On evaluation, her Upper GI scopy revealed dilated esophagus with sluggish peristalisis. Since the patient had tightness of skin over the distal extremities, face and fish mouth appearance with thinning of nail, Skin biopsy was taken. The skin biopsy was reported to be scleroderma.The esophageal manometry demonstrated failed esophageal peristalisis with high normal LES pressure due to tight fundal wrap.The patient was treated with mesh remova, Transhiatal esophagectomy with gastric pull-up and cervical Anastomosis.Post operatively the patient was treated with hydrocholoroquine and predinisolone. Results The patient is free of dysphagia and is on regular follow up. Conclusion In case of failure, detailed evaluation including High resolution manometry (MII HRM) has to be done before doing laparoscopic fundoplication for GERD has to rule out uncommon and rare disorders of esophagus. Detailed clinical examination in GERD patients has to be done to rule out systemic disease like scleroderma.In case of failed fundoplication for GERD, patients have to investigated for the failure.So patients with incapacitating esophageal neuromotor disease, a more radical approach in the form of esophagectomy may be safer and more reliable than attempting another procedure and risk another failure. Disclosure All authors have declared no conflicts of interest.

Adipose Tissue in the Filum Terminale: A Computed Tomographic Finding That May Indicate Tethering of the Spinal Cord

Neurosurgery ◽  
1988 ◽  
Vol 22 (5) ◽  
pp. 873-876 ◽  
Author(s):  
Roger E. McLendon ◽  
Jerry W. Oakes ◽  
Ralph E. Heinz ◽  
Andrew E. Yeates ◽  
Peter C. Burger
Keyword(s):  
Spinal Cord ◽  
Adipose Tissue ◽  
Low Back Pain ◽  
Back Pain ◽  
Ct Scan ◽  
Tethered Cord ◽  
Ct Scanning ◽  
Low Back ◽  
Filum Terminale ◽  
Computed Tomographic

Abstract Adipose tissue in the filum terminale is frequently associated with tethering of the spinal cord in patients with spina bifida occulta (3, 8). We recently saw a patient with low back pain and no spina bifida occulta, in whom adipose tissue was noted in the area of the filum on an unenhanced computed tomographic (CT) scan. The patient had a tethered cord. This case suggested that, when CT scanning is done as the first imaging study in the evaluation of low back pain, fatty tissue in the area of the filum may be an indicator for tethering of the spinal cord. The present study was undertaken to determine the validity of using CT scan-detectable filal fat in the identification of possible tethered spinal cords among a group of patients experiencing low back pain. The presence of fat in the fila of 12 patients with the radiologically and histologically tethered cord syndrome was evaluated and the fila of 47 autopsied patients whose clinical history showed no back pain were examined histologically. There were accumulations of adipose tissue in the fila of 11 of the 12 (91%) patients with the tethered cord syndrome and in the fila of 9 of the 47 patients (17%) in the autopsy series. Of the 9 autopsy patients with fat in their fila, however only 3 patients (6%) exhibited collections of adipose tissue in the CT detection range (2 mm). These results demonstrate that, although CT scan-detectable adipose tissue can be found in the filum of an occasional patient without tethered cord, CT detectable fat in the filum of a patient with low back pain should prompt an evaluation for a tethered spinal cord. CT scanning has potential as a noninvasive tool in such a work-up.

scholarly journals Case Report: Isolated hepatosplenic sarcoidosis treatment improving glycaemic control in a type 1 diabetic patient

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 50
Author(s):  
Sérgio Pina ◽  
Teresa Salero ◽  
Mariana Figueiras ◽  
Rui Osório ◽  
Sofia Amálio
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Angiotensin Converting Enzyme ◽  
Ct Scan ◽  
Enzyme Inhibitor ◽  
Systemic Disease ◽  
Insulin Dose ◽  
Beta Thalassemia ◽  
Converting Enzyme

Sarcoidosis is a multi-systemic disease characterized by non-caseating granulomas in various organs. The aetiology is still unknown. Although the liver is the third most commonly affected organ, hepatosplenic sarcoidosis without lung involvement is very uncommon. There is a high frequency of certain autoimmune illnesses observed in sarcoidosis, but association with type 1 diabetes is infrequent. We present the case of a 31-year-old woman, with type 1 diabetes mellitus diagnosed 22 years before with a glycated haemoglobin (HbA1c) above 14%, diabetic nephropathy, retinopathy and neuropathy, hypercholesterolemia and beta thalassemia. She was medicated with an angiotensin-converting enzyme inhibitor, a dihydropyridine calcium antagonist and insulin.   The patient presented with a 4-month history of tiredness, abdominal pain, weight lost and hepatosplenomegaly. Abdominal ultrasound revealed hepatomegaly with regular contours, diffuse heterogeneous texture, containing numerous nodules with slight enlargement of the spleen. Serum angiotensin converting enzyme (ACE) was 67 IU/L and a sedimentation rate of 120 mm/h. Computer tomography (CT) scan confirmed hepatosplenomegaly and suggested infiltration in both organs. Liver biopsies were compatible with sarcoidosis. After ruling other organ involvement, a diagnosis of isolated hepatosplenic sarcoidosis was provided and prednisolone (40mg/day) was started. After a few months the patient developed a corticoid-induced myopathy confirmed with electromyography. Prednisolone was reduced to 20mg/day and azathioprine (50mg/day) treatment initiated. After a 7-month treatment, chest-abdomen-pelvis CT scan showed a marked reduction of the nodularity and hepatosplenomegaly and after 1 year the patient was completely asymptomatic (HbA1c, 7.5%; ACE, 24IU/L). At 18-month follow-up there was no evidence of recurrence (HbA1c, 7%), with optimum glycaemic control with total daily insulin dose lowered to half. This is an uncommon case in which the treatment of hepatosplenic sarcoidosis with regression of sarcoid tissue can help explain the improvement of glycaemic control in this patient.

scholarly journals RE: Association of Abnormal Pulmonary Vasculature on CT Scan for COVID-19 Infection with Decreased Diffusion Capacity in Follow Up: a retrospective cohort study.

2021 ◽  
Author(s):  
Daniel Salerno ◽  
Ifeoma Oriaku ◽  
Melinda Darnell ◽  
Maarten Lanclus ◽  
Jan De Backer ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Ct Scan ◽  
Pulmonary Function Tests ◽  
Systemic Disease ◽  
Inflammatory Biomarkers ◽  
Pulmonary Vasculature ◽  
Healthy Controls ◽  
Tissue Segmentation ◽  
Function Tests

Abstract Background: Coronavirus Disease 2019 (COVID-19) is a highly contagious respiratory viral illness causing pneumonia and systemic disease. Abnormalities in pulmonary function after COVID-19 infection have been described. The determinants of these abnormalities are unclear. We hypothesized that inflammatory biomarkers and CT scan parameters at the time of infection would be associated with abnormal gas exchange at short term follow-up.Methods: We studied subjects who were hospitalized for COVID-19 pneumonia and then discharged. Serum inflammatory biomarkers, CT scan, and clinical characteristics were assessed during the hospitalization. CT images were evaluated by Functional Respiratory Imaging with automated tissue segmentation algorithms of the lungs and pulmonary vasculature. Volumes of the pulmonary vessels that were ≤5mm (BV5), 5-10mm (BV5_10), and ≥10mm (BV10) in cross sectional area were analyzed. Additionally, the amount of opacification on CT (i.e. ground glass opacities) was quantified in each patient. Pulmonary function tests were performed 2-3 months after discharge. We divided subjects into those with a DLCO <80% predicted (Low DLCO) and those with a DLCO ≥80% predicted (Normal DLCO) based on these pulmonary function tests. Results: 38 subjects were included in our analysis. 31 out of 38 (81.6%) subjects had a DLCO<80% predicted. Hemoglobin, inflammatory biomarkers, spirometry and lung volumes were similar between groups. CT opacification and BV5 were not different between groups, but both Low and Normal DLCO groups had lower BV5 measures compared to healthy controls. BV5_10 and BV10 measures were higher in the Low DLCO group compared to the Normal DLCO group. Both BV5_10 and BV10 in the Low DLCO group were greater compared to healthy controls. BV5_10 was independently associated with DLCO<80% in multivariable logistic regression (OR 1.29, 95% CI 1.01, 1.64). BV10 negatively correlated with DLCO% predicted (r=-0.343, p=0.035). Conclusions: Low DLCO is common after COVID-19 infection, and abnormalities in pulmonary vascular volumes at the time of hospitalization are independently associated with a low DLCO. There was no relationship between inflammatory biomarkers during hospitalization and DLCO. These findings suggest that pulmonary vascular abnormalities during hospitalization with COVID-19 might have long-lasting effects on pulmonary function.

scholarly journals COVID-19 Pneumonia: A Review of Typical Ct Findings and Differential Diagnosis

2020 ◽  
Vol 1 (3) ◽  
pp. 01-22
Author(s):  
Anthony Venyo
Keyword(s):  
Ct Scan ◽  
Imaging Techniques ◽  
Systemic Disease ◽  
Variable Number ◽  
Emergency Setting ◽  
Test Results ◽  
Imaging Characteristics ◽  
Novel Coronavirus ◽  
High Index Of Suspicion ◽  
Acid Test

Pneumonia that is caused by the 2019 novel coronavirus (SARS-CoV-2, which is also referred to as 2019-nCoV recently did break out in Wuhan China has been coined the terminology of COVID-19. With the spread of the disease, similar cases of COVID-19 had been confirmed in various regions of the world. Because COVID-19 is a relatively new global disease, clinicians, and patients across the globe would initially not be conversant with the clinical features and radiology imaging characteristics of SARS-CoV-2 pneumonia. The causes of pneumonia are protein, many secondary to an underlying cardiorespiratory abnormality while some are related systemic disease. Various imaging techniques generally diagnose cases of Pneumonia. In the current climate, COVID-19 Pneumonia has taken center stage; confirmation relies upon microbiological studies such as real-time polymerase chain reaction or sequencing. These investigations are not usually available in an emergency setting. Computed Tomography (CT) can be used as an essential complement for the diagnosis of COVID-19 Pneumonia in the current epidemic context. But the later may be misleading as other cases of Pneumonia, and interstitial lung disease can easily be confused with COVID-19 Pneumonia. Also, Covid19 Pneumonia may be missed if not considered. The attention of clinicians should be alerted to the possibility of COVID-19 to conduct the appropriate tests to confirm or negate the diagnosis of COVID-19. In asymptomatic as well as in symptomatic patients that have COVID1-9 pneumonia, the initial COVID-19 nuclei acid test results could be normal, which upon subsequent repeat testing would become normal. Still, radiology imaging using a CT scan of thorax would tend to demonstrate various non-specific features that affect a variable number of lobes of the lungs, and these features quickly increase in size when a repeat CT scan of the thorax is undertaken. These findings tend to predate positive COVID-19 test results in some cases of COVID-19. The non-specific changes tend to resolve when the patient resolves from COVID-19 pneumonia. A catalog of radiology images that demonstrate various types of cardio-pulmonary lesions which when encountered by clinicians should alert them to exclude the possibility of COVID-19 Pneumonia has been included in the paper as an aid to alerting clinicians to have a high index of suspicion of radiology images of the thorax which should help them to quickly undertake appropriate tests to confirm or negate the diagnosis of COVID-19 pulmonary infection.

scholarly journals A national intervention to reduce imaging for low back pain by general practitioners: a retrospective economic program evaluation using Medicare Benefits Schedule data

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tessa Morgan ◽  
Jianyun Wu ◽  
Ludmila Ovchinikova ◽  
Robyn Lindner ◽  
Suzanne Blogg ◽  
...  
Keyword(s):  
Time Series ◽  
Low Back Pain ◽  
Back Pain ◽  
Diagnostic Imaging ◽  
Ct Scan ◽  
Ct Scans ◽  
Low Back ◽  
X Ray ◽  
Lower Back ◽  
Program Costs

Abstract Background The overuse of diagnostic imaging for low back pain (LBP) in Australia results in unnecessary cost to the health system and, for patients, avoidable exposure to radiation. The 2013 NPS MedicineWise LBP program aimed to reduce unnecessary diagnostic imaging for non-specific acute LBP in the Australian primary care setting. The LBP program delivered referral pattern feedback, a decision support tool and patient information to 19,997 (60%) of registered Australian general practitioners (GPs). This study describes the findings from evaluation of the effectiveness of the 2013 LBP program at reducing X-ray and computed tomography (CT) scans of the lower back, and the financial costs and benefits of the program to the government funder. Methods The effectiveness of the 2013 LBP program was evaluated using population-based time-series analysis of administrative claims data of Medicare Benefits Schedule (MBS) funded X-ray and CT scan services of the lower back. The CT scan referral trend of non-GP health professionals was used as an observational control group in a Bayesian structural time-series model. A retrospective cost–benefit analysis and cost-effectiveness analysis was conducted using program costs from organisational records and reimbursement data from the MBS. Results The 2013 NPS MedicineWise LBP program was associated with a statistically significant 10.85% relative reduction in the volume of CT scans of the lumbosacral region, equating to a cost reduction to the MBS of AUD$11,600,898. The best available estimate of program costs was AUD$141,154. Every dollar of funding spent on the 2013 LBP program saved AUD$82 of funding to the MBS for CT scan reimbursements. Therefore, from the perspective of the Australian Government Department of Health, the 2013 LBP program was cost saving. The program cost AUD$2.82 per CT scan averted in comparison to the scenario of no program. No association between the 2013 NPS MedicineWise LBP program and the volume of X-ray items on the MBS was observed. Conclusions The 2013 NPS MedicineWise LBP program reduced CT scan referral by GPs, in line with the program’s messages and clinical guidelines. Reducing this low-value care produced savings to the health system that exceeded the costs of program implementation.

The Proliferating and Malignant Proliferating Trichilemmal Cyst: An Anatomo-Clinical Study of Three Cases

2021 ◽  
pp. 1-4
Author(s):  
Ibtissam Benslimane Kamal ◽  
Fouzia Hali ◽  
Farida Marnissi ◽  
Soumiya Chiheb
Keyword(s):  
Clinical Study ◽  
Skin Biopsy ◽  
Clinical Characteristics ◽  
Transitional Form ◽  
Ulcerative Lesion ◽  
The Third ◽  
Trichilemmal Cyst ◽  
Proliferating Trichilemmal Cyst ◽  
Central Ulceration ◽  
Adnexal Tumors

<b><i>Background:</i></b> The proliferating and malignant proliferating trichilemmal cysts (MPTC) are rare adnexal tumors. We report 3 cases through which we will detail the anatomo-clinical characteristics of these tumors. <b><i>Cases:</i></b> Two patients, 60 and 56 years old, consulted for multiple scalp nodules, one of which had changed with the appearance of a central ulceration. The removal of the remaining scalp nodules was in favor of PTCs. The third patient presented with an ulcerative lesion occupying the vertex. Skin biopsy found trichilemmal-type keratinization associated with areas of necrosis concluding with a MPTC. <b><i>Discussion:</i></b> The PTC is a transitional form between the trichilemmal cyst (TC) and the MPTC. The increase in the size of a TC and ulceration are sufficient signals to suspect this evolution.

Phase II Trial of Oral Panobinostat (LBH589) in Patients with Refractory Cutaneous T-Cell Lymphoma (CTCL).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1005-1005 ◽  
Author(s):  
Madeleine Duvic ◽  
Jürgen C. Becker ◽  
Stephane Dalle ◽  
Francisco Vanaclocha ◽  
Maria Grazia Bernengo ◽  
...  
Keyword(s):  
T Cell ◽  
Ct Scan ◽  
Phase Ii ◽  
Cell Lymphoma ◽  
Systemic Disease ◽  
T Cell Lymphoma ◽  
Cutaneous T Cell Lymphoma ◽  
Efficacy And Safety ◽  
Deacetylase Inhibitor ◽  
Skin Responses

Abstract Background: Panobinostat is a histone deacetylase inhibitor that has shown promising results in cutaneous T-cell lymphoma (CTCL). Objectives: An open-label, multicenter, Phase II study is being conducted with a primary objective of establishing the efficacy and safety of the pan-deacetylase inhibitor, panobinostat (LBH589), for patients (pts) with relapsed/refractory CTCL with Stage IB–IVA mycosis fungoides (MF) or Sézary syndrome (SS). Methods: Inclusion criteria include adequate organ function, no clinically significant cardiovascular abnormalities (QTcF ≤ 450 ms, ECOG PS ≤2), failure of ≥2 prior systemic therapies, and no prior HDAC inhibitor treatment. Pts were grouped as having bexarotene therapy (Group [Gr] 1) or bexarotene naïve (Gr 2). Panobinostat was administered at a dose of 20 mg orally on Days 1, 3, 5, weekly, every 28 days until progression or unacceptable toxicity. Response was based on a composite score, including skin assessment with the modified Severity-Weighted Assessment Tool (mSWAT) and systemic disease assessed by CT scan. Results: To date, 95 pts (Gr 1=62; Gr 2=33) have enrolled with median age of 58 yrs [range 25–88]: 58 male, 37 female; 70 MF, 25 SS. Median prior treatment regimens are 4 and 3 for Gr 1 and 2, respectively. Most pts were ≥Stage IIB at study entry (Gr 1=42; Gr 2=26) and received 1–17+ (median=3) treatment cycles of panobinostat. In Gr 1, 11/62 pts have had confirmed skin responses by SWAT, including 2 complete skin responses. Confirmatory CT scans are pending for 2 patients. In Gr 2, 4/33 pts had confirmed skin and CT scan responses. Common AEs (&gt;20%; all grades, regardless of causality) included diarrhea, thrombocytopenia, nausea, pruritus, fatigue, and asthenia, and Grade 3/4 AEs (&gt;2%, regardless of causality) included thrombocytopenia, neutropenia, pruritus, diarrhea, and hypophosphatemia. Of 4,542 ECGs analyzed, 2 pts have had QTcF &gt;480 ms; 4 had QTcF &gt;60 ms increase from baseline. Conclusions: Panobinostat continues to demonstrate encouraging clinical activity with a manageable safety profile in pts with CTCL. Per predefined criteria, Group 2 enrollment to Stage 2 is open. Updated efficacy and safety data will be presented.

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