Iliopsoas Abscess in a 24-Months-Old Child: Management in Absence of an Identifiable Organism

Liaquat National Journal of Primary Care ◽

10.37184/lnjpc.2707-3521.1.11 ◽

2020 ◽

Keyword(s):

Staphylococcus Aureus ◽

Hip Joint ◽

Psoas Muscle ◽

Blood Cultures ◽

Three Dimensions ◽

High Grade ◽

High Grade Fever ◽

Iliopsoas Abscess ◽

The Right ◽

Peripheral Enhancement

Iliopsoas abscess presents with vague and variable symptoms and is less commonly encountered in a clinical setting. The most common causative agent is staphylococcus aureus. In our case, a 2-year-old boy presented with high-grade fever, difficulty in walking, and pain in the right leg near the hip joint. Psoas sign was positive but his blood cultures were negative and CT scan showed a necrotic mass with peripheral enhancement measuring 7.0x4.2x2.6 cm in all three dimensions in right Psoas muscle. Biopsy of the abscess was denied and the patient was managed conservatively with intravenous ceftriaxone and metronidazole. This case highlights the importance of clinical examination and then co-relating it radiologically and focuses on the importance of broad-spectrum antibiotics when necessary investigation (biopsy in our case) is denied.

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Eosinophilic lung disease as a sequela of MSSA pneumonia

BMJ Case Reports ◽

10.1136/bcr-2020-239304 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239304

Author(s):

Syed Muhammad Zubair ◽

Muhammad Zaid Hamid Hussain ◽

Ali Bin Sarwar Zubairi

Keyword(s):

Emergency Department ◽

Staphylococcus Aureus ◽

Bronchoalveolar Lavage ◽

Complete Resolution ◽

Lung Diseases ◽

Disease Process ◽

High Grade ◽

Shortness Of Breath ◽

High Grade Fever ◽

Rare Group

Eosinophilic lung diseases are a rare group of lung disorders with multiple known and unknown aetiologies and the diagnosis is often challenging. We present a case of a young man who was admitted with pneumonia due to methicillin-sensitive Staphylococcus aureus and was discharged on antibiotics. He presented to the emergency department approximately 2 weeks after discharge with high-grade fever, cough and shortness of breath associated with serum and bronchoalveolar lavage eosinophilia. He was then treated with steroids with complete resolution of disease process.

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P1498 Right atrial thrombus in a young septic patient with lymphoma

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.922 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Habjan ◽

B Erzen ◽

M Miklic ◽

A Skarlovnik

Keyword(s):

Staphylococcus Aureus ◽

Right Atrium ◽

Inflammatory Markers ◽

Clinical Status ◽

Left Knee ◽

Blood Cultures ◽

Right Atrial ◽

Atrial Thrombus ◽

The Right ◽

And Staphylococcus Aureus

Abstract Background Catheter-related right atrial thrombosis is a rare, but potentially life threatening complication in patients with central venous catheters (CVCs). Echocardiography is an indispensable tool in the diagnosis of right atrial thrombosis. We present a case of a young man with lymphoma, Staphylococcus aureus sepsis and a peripherally inserted central catheter (PICC) who had a septic thrombus in the right atrium. Case summary A 23-year-old male patient with recently diagnosed Hodgkin’s lymphoma had an inserted PICC for the purpose of chemotherapy application. Three days after the first chemotherapy application a thrombosis of the cephalic and subclavian veins at the site of PICC was found. The PICC was removed and the patient was treated with therapeutic doses of dalteparin. A day after the discovery of thrombosis, the patient became clinically septic, with high inflammatory markers and Staphylococcus aureus was isolated from his blood cultures. He was promptly treated with flucloxacillin. Due to pain in his left knee, a knee puncture was performed, and Staphylococcus aureus was isolated also from the knee synovial fluid. A transthoracic echocardiography revealed a 2.8 x 2.8 cm sessile thrombus on the lateral wall of the right atrium. There were no vegetations on the tricuspid or other valves. Due to increasing pain in his left knee and an increase in inflammatory markers a synovectomy was performed. After the operation the clinical status improved and the inflammatory parameters decreased. A magnetic resonance imaging of the heart was performed, which confirmed the thrombus described by echocardiography and excluded the presence of abscesses. All the time the patient was treated in the intensive care unit with standard heparin, flucloxacillin, and piperacillin/tazobactam due to neutropenia. The inflammatory markers slowly decreased and all further blood cultures were negative. Follow-up echocardiography after 16 days of antibiotic and anticoagulant therapy revealed that the mass in the right atrium, attached on the lateral atrium wall, was slightly smaller than before. The mass was centrally un-echogenic with echogenic cover, appearing as a partial regression of the septic thrombus with a central colliquation. The heart valves remained free of vegetations. There was a minor pericardial effusion, with no signs of constriction. Due to improved clinical status the patient was able to start with chemotherapy again after a pause of three weeks. Conclusion The patient had three important risk factors for thrombosis: PICC, sepsis and malignancy. Echocardiography is an important tool for mass diagnosis and the exclusion of vegetations in a septic patient. Often there is a need for further specification of the mass etiology or for the exclusion of other pathology, like abscesses in our case. Magnetic resonance is an important tool that can complement the echocardiographic examination. Abstract P1498 Figure. Right atrial thrombus

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Disseminated Tuberculosis with Involvement of Appendix, Peritoneum and Right Knee Joint - A Case Report

Journal of Medicine ◽

10.3329/jom.v15i2.20702 ◽

2014 ◽

Vol 15 (2) ◽

pp. 153-155

Author(s):

Mohammad Syedul Islam ◽

Md. Abul Kalam Azad ◽

Hanif Mohammad ◽

Mohammad Mushahidul Islam ◽

Md. Abdur Rahim

Keyword(s):

Abdominal Pain ◽

Knee Joint ◽

Iliac Fossa ◽

Joint Fluid ◽

High Grade ◽

High Grade Fever ◽

Disseminated Tuberculosis ◽

Initial Episode ◽

The Right ◽

Neutrophilic Leucocytosis

A 27 year old male presented with painful swelling of right knee joint for the last 6 months. Initially it was diagnosed as a case of reactive arthritis and was treated with NSAID with intraarticular steroids without significant improvement. Two months after the initial episode he again developed painful swelling of the right knee joint with severe abdominal pain and high grade fever. There was an ill defined ovoid mass in the right iliac fossa with generalized tenderness. ESR was raised and the ultrasonography revealed loculated ascites with appendicular lump. CT scan of the whole abdomen showed appendicular lump. FNAC from the lump showed tuberculosis. Joint fluid aspiration showed neutrophilic leucocytosis with the Total count 50,000/cmm. AFB was not found. So septic arthritis was diagnosed, but as the patient was not improving we send the patient to orthopedic department for synovial biopsy but they refused as it was septic. So a diagnosis of disseminated Tuberculosis was made with the involvement of right knee joint, appendix and peritoneum. He was put on anti TB and well responded.DOI: http://dx.doi.org/10.3329/jom.v15i2.20702 J MEDICINE 2014; 15 : 153-155

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Propiedades psicométricas de la Escala de Autoritarismo de Derechas en población colombiana

10.31234/osf.io/txw7k ◽

2020 ◽

Author(s):

Efrain Garcia-Sanchez ◽

Nelson Molina Valencia ◽

Estefanía Buitrago ◽

Zabdi Sanz ◽

Valentina Ramírez ◽

...

Keyword(s):

Psychometric Properties ◽

Empirical Evidence ◽

Social Dominance ◽

Three Dimensions ◽

Social Policies ◽

The Right

El autoritarismo es un constructo ampliamente estudiado en psicología para investigar comportamientos políticos. Para su medición se suele usar la escala de autoritarismo de derechas (RWA), la cual tiene variaciones en sus propiedades psicométricas según cada contexto. En este artículo traducimos y adaptamos una versión reducida del autoritarismo de derechas al contexto colombiano. En dos estudios (NEstudio1=417;NEstudio2=396), identificamos tres dimensiones: agresión-autoritaria, sumisión-autoritaria y convencionalismo; y encontramos que la RWA estuvo asociada positivamente con: dominancia social, deshumanización del adversario, apoyo al conflicto, patriotismo, sexismo, homofobia y la prohibición de políticas sociales consideradas como liberales (e.g., aborto, matrimonio igualitario, eutanasia). Se aporta evidencia empírica a favor de las propiedades psicométricas de la escala de RWA en el contexto colombiano. Authoritarianism is widely used construct to study political behaviors.For its measurement, researchers usually use the right authoritarianism scale (RWA), which has variations in its psychometric properties according to each context. In this article we translate and adapt a reduced version of RWA to the Colombian context. In two studies (NStudy1=417; NStudy2=396), we identified three dimensions: authoritarian-aggression, authoritarian-submission,and conventionalism. We also found that RWA was positively associated with: social dominance, dehumanization of the adversary, support for conflict, patriotism, sexism, homophobia and the prohibition of social policies considered liberal (e.g., abortion, equal marriage, euthanasia). Empirical evidence is provided in favor of the psychometric properties of the RWA scale in the Colombian context

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A CBCT Based Three-Dimensional Assessment of Mandibular Posterior Region for Evaluating the Possibility of Bypassing the Inferior Alveolar Nerve While Placing Dental Implants

Diagnostics ◽

10.3390/diagnostics10060406 ◽

2020 ◽

Vol 10 (6) ◽

pp. 406 ◽

Cited By ~ 3

Author(s):

Mohammed G. Sghaireen ◽

Kumar Chandan Srivastava ◽

Deepti Shrivastava ◽

Kiran Kumar Ganji ◽

Santosh R. Patil ◽

...

Keyword(s):

Nerve Injury ◽

Age Groups ◽

Inferior Alveolar Nerve ◽

Three Dimensions ◽

High Rate ◽

Cortical Plate ◽

Computed Tomography Images ◽

Group I ◽

Linear Distance ◽

The Right

A high rate of nerve injury and related consequences are seen during implant placement in the posterior mandibular arch. An approach has been proposed to avoid nerve injury by dodging the inferior alveolar nerve (IAN) while placing an implant. A prospective study with a total of 240 CBCT (cone beam computed tomography) images of patients with three dentate statuses, namely, edentulous (group I), partially edentulous (group II) and dentate (group III) were included in the study. The nerve path tracing was done on CBCT images with On-demand 3D software. The three dimensions, i.e., the linear distance from the outer buccal cortical plate to the inferior alveolar nerve (BCPN), linear distance from the outer lingual cortical plate to the inferior alveolar nerve (LCPN) and linear distance from the midpoint of the alveolar crest to the inferior alveolar nerve (ACN) were assessed. The data were presented and analyzed between variables using one-way ANOVA and independent t-test in SPSS version 21.LCPN of the right 1st premolar region (p < 0.05) was significantly different among the groups with edentulous subjects recorded with the minimum value (6.50 ± 1.20 mm). Females were found to have significantly (p < 0.05) less available bone (6.03 ± 1.46 mm) on the right side of the mandibular jaw compared to males in edentulous group of patients. On comparing age groups for partially edentulous subjects, LCPN of the right 1st premolar region had significantly (p < 0.05) less available bone (6.03 ± 0.38 mm) in subjects with age ≥54 years. The IAN follows a lingual course in the molar region and later flips to the buccal side in the premolar region. The LCPN dimension in the 1st and 2nd premolar region was found to be more than 6 mm irrespective of age, gender and side of the jaw. Thus, it can be considered as a suitable site for placing implants while bypassing the IAN with CBCT assessment remaining as the mainstay in the pre-surgical phase.

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A Challenging Case of A Myeloid Sarcoma Misdiagnosed as High Grade B-Cell Lymphoma

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.212 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S97-S97

Author(s):

A Herrmann ◽

B Mai ◽

S Elzamly ◽

A Wahed ◽

A Nguyen ◽

...

Keyword(s):

Bone Marrow ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Myeloid Sarcoma ◽

Proliferation Index ◽

High Grade ◽

Cell Markers ◽

Thoracolumbar Region ◽

The Right

Abstract Introduction/Objective A 46-year-old female presented with severe back pain associated with progressive bilateral lower extremity weakness and paresthesia, urinary retention, and constipation. Computed tomography revealed a retroperitoneal mass encasing the right psoas muscle, obstructing the right kidney, and extending to the thoracolumbar region resulting in severe spinal compression. An epidural tumor resection was subsequently performed at an outside hospital. Methods Histological sections showed sheets of blastoid neoplastic cells with intermediate to large nuclei, irregular membranes, fine chromatin, and prominent nucleoli. Immunohistochemical stains showed that these cells were positive for CD43, CD79a (weak, focal), BCL2, C-MYC, and PAX5 (weak, focal) and negative for CD10, CD20, CD30, ALK1, BCL6, MUM1, and Tdt. The Ki-67 proliferation index was 75-80%. With this immunophenotype, this patient was diagnosed with a high grade B-cell lymphoma and transferred to our institution for further work-up. On review of the slides, further immunohistochemical testing was requested which revealed positivity for CD117 and myeloperoxidase (MPO). Results The overall morphological and immunophenotypical features are most compatible with myeloid sarcoma (MS) with aberrant expression of B-cell markers and this patient’s diagnosis was amended. Interestingly, the patient’s bone marrow examination only showed 2% myeloblasts with left shifted granulocytosis and concurrent fluorescence in situ hybridization (FISH) studies were negative. Conclusion A literature review showed that 40-50% of MS are misdiagnosed as lymphoma. MS can frequently stain with B-cell or T-cell markers, as seen in this case, which makes it challenging for an accurate diagnosis and sub- classification. In addition, our case is interesting in that there was only extramedullary presentation without bone marrow involvement. Typically, MS develops after the diagnosis of acute myeloid leukemia (AML) with an incidence of 3–5% after AML. It can also manifest de novo in healthy patients, who then go on to develop AML months to years later. Therefore, this patient will require close follow-up.

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Comparing Glioblastoma Surgery Decisions Between Teams Using Brain Maps of Tumor Locations, Biopsies, and Resections

JCO Clinical Cancer Informatics ◽

10.1200/cci.18.00089 ◽

2019 ◽

pp. 1-12 ◽

Cited By ~ 8

Author(s):

Domenique M.J. Müller ◽

Pierre A.J.T. Robe ◽

Roelant S. Eijgelaar ◽

Marnix G. Witte ◽

Martin Visser ◽

...

Keyword(s):

Tumor Location ◽

Three Dimensions ◽

Multidisciplinary Teams ◽

Surgical Removal ◽

Treatment Variation ◽

Probability Maps ◽

Resected Patient ◽

The Right ◽

Referral Bias ◽

The Brain

Purpose The aim of glioblastoma surgery is to maximize the extent of resection while preserving functional integrity, which depends on the location within the brain. A standard to compare these decisions is lacking. We present a volumetric voxel-wise method for direct comparison between two multidisciplinary teams of glioblastoma surgery decisions throughout the brain. Methods Adults undergoing first-time glioblastoma surgery from 2012 to 2013 performed by two neuro-oncologic teams were included. Patients had had a diagnostic biopsy or resection. Preoperative tumors and postoperative residues were segmented on magnetic resonance imaging in three dimensions and registered to standard brain space. Voxel-wise probability maps of tumor location, biopsy, and resection were constructed for each team to compare patient referral bias, indication variation, and treatment variation. To evaluate the quality of care, subgroups of differentially resected brain regions were analyzed for survival and functional outcome. Results One team included 101 patients, and the other included 174; 91 tumors were biopsied, and 181 were resected. Patient characteristics were largely comparable between teams. Distributions of tumor locations were dissimilar, suggesting referral bias. Distributions of biopsies were similar, suggesting absence of indication variation. Differentially resected regions were identified in the anterior limb of the right internal capsule and the right caudate nucleus, indicating treatment variation. Patients with (n = 12) and without (n = 6) surgical removal in these regions had similar overall survival and similar permanent neurologic deficits. Conclusion Probability maps of tumor location, biopsy, and resection provide additional information that can inform surgical decision making across multidisciplinary teams for patients with glioblastoma.

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