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2022 ◽  
pp. 541-543
Author(s):  
Nidha Gaffoor ◽  
Hima Sree Edupuganti ◽  
Jessica Minal ◽  
Archana Shetty ◽  
Supriya T R ◽  
...  

Calcinosis cutis is an uncommon soft tissue lesion characterized by the deposition of calcium salts in the skin or subcutaneous tissue attributed to a wide variety of causes. We present a case of idiopathic calcinosis cutis in an adult male, who presented with a swelling in the right iliac region. Chalky white aspirate and amorphous basophilic granular material on microscopy suggestive of calcium deposits were noted. Histopathological examination of the excised mass coupled with appropriate clinical background led to the final diagnosis of idiopathic calcinosis cutis. We present this case with a complete diagnostic workup to undermine the importance of considering this lesion in the differential diagnoses of a subcutaneous hard lump in an otherwise healthy patient.


2021 ◽  
pp. 102992
Author(s):  
Mohamad Antakle ◽  
Mohammed Moutaz Alshaghel ◽  
Ghina Ghannam ◽  
Mais Al-Ibraheem ◽  
Linda Shehade ◽  
...  

Author(s):  
Дмитрий Валериевич Судаков ◽  
Олег Валериевич Судаков ◽  
Евгений Владимирович Белов ◽  
Наталья Владимировна Якушева ◽  
Оксана Анатольевна Тюрина

Статья посвящена анализу особенностей клинико-соноскопических показателей острого аппендицита (ОА) у молодежи. Тематика является актуальной, так как в декабре 2020 года, правительством РФ были изменены возрастные рамки понятия «молодежь» - увеличены с 30 до 35 лет. Особенностью работы стало использование УЗИ - методик в комплексной диагностике ОА, которые в настоящее время не являются обязательными в стандарте обследования пациентов с подозрением на ОА. Данная работа стала результатом попытки выявить основные клинико-соноскопические симптомы ОА у молодежи, которые могли бы своевременно помочь с адекватной дифференциальной диагностикой в будущем и возможно «лечь» в основу будущего стандарта обследования. Объектами исследования послужило 150 пациентов, мужчин и женщин, в возрасте от 18 до 35 лет, мужчин (n=71) и женщин (n=59). Все больные были разделены на 3 группы по 50 человек. В 1 группу вошли больные, поступающие с жалобами на боли различного характера в области живота, которым впоследствии не был установлен диагноз ОА. 2 группу составили пациенты, которым выполняли общее УЗИ обследование органов брюшной полости и у которых впоследствии был подтвержден диагноз ОА. В 3 группу вошли пациенты, которым отдельно выполняли УЗИ правой подвздошной области и у которых впоследствии также подтверждался диагноз ОА. Основой исследования стал подробный анализ жалоб (клинических проявлений) пациентов, изучение их температуры тела и локализации боли. Так, у пациентов с ОА наиболее частой локализацией стала правая подвздошная область, а температура редко превышала 37,5 С. В дальнейшем, в работе был проведен комплексный анализ ОАК и Б/Х крови. Было установлено, что у пациентов с ОА наиболее значимо определялись изменения «маркеров» воспалительного процесса - лейкоцитоз, СОЭ, нейтрофильный сдвиг влево; изменения биохимии наоборот-были свойственны пациентам 1 группы - без ОА. Интересной особенностью стало выявление сопутствующих хронических заболеваний. Отмечалось, что с повышением возраста «молодежи» выявлялся и рост числа различных заболеваний. В завершении исследования проводилось изучение данных УЗИ-симптомов, которые были разделены на прямые и косвенные. Статья интересна практикующим врачам - хирургам и УЗИ-диагностам The article is devoted to the analysis of the features of the clinical and sonoscopic indicators of acute appenicitis (OA) in young people. The topic is relevant, since in December 2020, the government of the Russian Federation changed the age range of the concept of "youth" - increased from 30 to 35 years. A feature of the work was the use of ultrasound - techniques in the complex diagnosis of OA, which are currently not mandatory in the standard of examination of patients with suspected OA. This work was the result of an attempt to identify the main clinical and sonoscopic symptoms of OA in young people, which could promptly help with adequate differential diagnosis in the future and possibly "form" the basis of the future examination standard. The objects of the study were 150 patients, men and women, aged 18 to 35 years, men (n = 71) and women (n = 59). All patients were divided into 3 groups of 50 people each. Group 1 consisted of patients admitted with complaints of pains of various nature in the abdominal region, who were not subsequently diagnosed with OA. Group 2 consisted of patients who underwent a general ultrasound examination of the abdominal organs and in whom the diagnosis of OA was subsequently confirmed. Group 3 included patients who underwent a separate ultrasound examination of the right iliac region and who subsequently also had a diagnosis of OA. The study was based on a detailed analysis of complaints (clinical manifestations) of patients, the study of their body temperature and localization of pain. Thus, in patients with OA, the most frequent localization was the right iliac region, and the temperature rarely exceeded 37.5 C. Later, a comprehensive analysis of the OAC and B / C blood was carried out in the work. It was found that in patients with OA, the most significant changes in the "markers" of the inflammatory process were determined - leukocytosis, ESR, neutrophilic shift to the left; changes in biochemistry, on the contrary, were characteristic of patients of group 1 - without OA. An interesting feature was the identification of concomitant chronic diseases. It was noted that with an increase in the age of the "youth", an increase in the number of various diseases was also revealed. At the end of the study, we studied the data of ultrasound symptoms, which were divided into direct and indirect. The article is interesting for practicing doctors - surgeons and ultrasound diagnostics


2021 ◽  
Vol 8 ◽  
Author(s):  
Zai-Shang Li ◽  
Hui Han ◽  
Chuang-Zhong Deng ◽  
Yong-Hong Li ◽  
Chong Wu ◽  
...  

Background: The aim of this study is to determine the necessary extent of penile lymph node dissection (PLND) in penile cancer patients with inguinal lymph node extracapsular extension (ILN-ENE).Methods: Penile cancer patients who underwent PLND in 15 centers from January 2006 to April 2020 were retrospectively analyzed. PLND was performed in patients with ILN-ENE.Results: Sixty-two patients with ILN-ENE were included in the analysis. A total of 51.6% (32/62) of the patients were confirmed to have pelvic lymph node metastasis (PLNM), and 31.3% (10/32) of patients were confirmed to have multiple PLNMs. Of the patients with metastases, 59.4% (19/32) had bilateral inguinal lymph node metastasis (ILNM). According to the anatomical structure, 71.9% (23/32) of the patients had PLNM in the external iliac region, and 56.2% (18/32) had PLNM in the obturator region. Among those with oligo-PLNM, 65.1% (28/43) of the patients had PLNM in the external iliac region and 38.9% (15/43) had PLNM in the obturator region. A significant overall survival difference was observed between patients with the bilateral ILNM and unilateral ILNM (36-month: 21.2 vs. 53.7%, respectively, P = 0.023). Patients with bilateral ILNM had relatively poor metastasis-free survival compared with unilateral ILNM (36-month: 33.0 vs. 13.9%, respectively, P = 0.051).Conclusions: The external iliac and obturator region were the most commonly affected regions in patients with ILN-ENE, and these regions were the only affected regions in patients with oligo-PLNM. Patients with bilateral ILNM had a high risk of PLNM and worse survival.


2021 ◽  
Vol 14 (6) ◽  
pp. e240299
Author(s):  
Padma Vikram Badhe ◽  
Dasari Ravi Kiran ◽  
Harini Seshadri

A 52-year-old woman was referred to our department with multiple discharging sinuses and swelling in the right flank and iliac region for the past year. Ultrasound revealed a large collection in the right psoas muscle with the sinus tract reaching up to the skin in the right iliac region. Despite repeated attempts at drainage, the collection continued to increase in size. CT was requested and revealed a large heterogeneous irregular collection in the right psoas with fistulous communication with the cecum and skin with the erosion of the overlying ilium. Because of lack of vertebral involvement, enhancing internal septations, non-visualisation of the appendix and feculent material admixed with mucinous discharge from the sinus, pseudomyxoma retroperitonei secondary to ruptured mucinous neoplasm of the appendix was suspected. Mucoid material at the local site was sent for histopathology, which confirmed our suspicion. Our treatment plan after ileostomy was cytoreductive surgery along with adjuvant radiotherapy (40 Gy in 20 fractions) with chemotherapy (5-fluorouracil and folinic acid given for 30 weeks, once a week). However, after ileostomy, the patient refused further treatment, citing financial reasons.


2021 ◽  
Vol 22 (1) ◽  
pp. 84-85
Author(s):  
Mohammad Mahfuzul Hoque ◽  
Ponkaj Kanti Datta

Contrast enhance CT scan of Abdomen showing a large encysted collection at the left of the abdomen extending from lumbar region to left iliac region pushing the surrounding viscera forward. Collection was due to retro-peritoneal hemorrhage in a Middle aged Lady with COVID-19 who was on therapeutic dose of anticoagulation with Low Molecular Weight Heparin. J MEDICINE JAN 2021; 22 (1) : 84-85


Author(s):  
Svetlana V. Shutova ◽  
Alina S. Segeda

We considered the current problem of determining pain sensitivity of different sections of the human body to find the most painless and safe zones for different medical procedures. The study involved 3 groups of students, 8 people in each group. In the first group were Russian boys, in the second – Russian girls, in the third – African girls aged 18–22 years. We carried out studies in 8 areas of the body, which are most often used in medicine for injecting: cheek, shoulder, forearm, wrist, underarm, shin behind (under the knee), iliac and gluteal areas. These areas are most commonly used for various medical procedures. We determined objective differences of sensitivity thresholds of different body sections. As the threshold increases (decrease in sensitivity), these are: underarm, forearm, iliac region, lower leg behind, gluteal region, shoulder. There were no pronounced sexual features of pain sensitivity among boys and girls 18–20 years old. We revealed ethnic features of skin sensitivity. The overall sensitivity of African students is higher than that of Russians. Taking into account the features of tactile and pain sensitivity will reduce the negative sensations of patients during pain-provoking procedures.


Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 37-37
Author(s):  
Iolanda Donatella Vincelli ◽  
Patrizia Cufari ◽  
Carmelo Toscano ◽  
Al Sayyad Said ◽  
Mauro Campello ◽  
...  

Chronic lymphocytic leukemia (CLL) is an indolent lymphoproliferative disorder and is manifested by progressive accumulation of B cells in the blood, bone marrow and lymphatic tissues. Chronic Myeloid Leukemia (CML) is a clonal myeloproliferative disorder characterized by the presence of all the stages of myeloid development in the peripheral blood, and it is believed to be driven by the aberrant protein tyrosine kinase, a product of the mutant BCR-ABL1 gene.Multiple Myeloma (MM) is characterized by the accumulation of clonal plasmcells in the bone marrow with skeletal lesions, anemia, hypercalcemia and renal failure. Our patient is a 78 year-old man. In 2014 diagnosis of CLL and monoclonal gammopathy of undetermined significance (MGUS).At diagnosis: HB 13.5 g/dl; normal renal function;calcium 8.7 mg/dl;IgG 1678 mg/dl,serum immunoelectrophoresis: IgG kappa, Bence Jones kappa; total protein 7.5 g/dl, beta1 6,5%, beta2 24,1%;peripheral blood immunophenotyping showed CLL, FISH:negative;Cariotype: 46, XY; RX skeleton: positive for osteolytic lesions, total body TC scan: adenopathies of 18 mm and 15 mm at bilateral axillary level, norma spleen, adenopathy of 22 cm in the left obturator iliac region; presence of left hip prosthesis; bone marrow biopsy: localization by low-grade plasmacytoma.No CLL.The patient was only observed until April 2015, when there was a presence of myelocytes and metamyelocytes in peripheral blood and an increased spleen (18 cm). So he performed : bone marrow aspirate: diagnosis of CML (Sokal Score: 1,34 H; Eutos Score: 60 L, Hasford Score 1488,5);bone marrow biopsy: suggestive for a myeloproliferative disease (CML), MGUS with a modest lymphoid B component,BCR-ABL: 60;FISH: pathological presence of double fusion signal of the ABL1 and BCR loci in 209 of 271 interphase nuclei examined (77%).The patient started therapy with Imatinib, 400mg/die until July 2015, on the basis of the good response to treatment and the progressive increase of the M component that confirmed the progression to MM: Hb 9.1 g/dL, creatinine 1,1 mg/dl;calcium 10,5 mg/dl;total protein: 8,6 g/dl, gamma 48.02% (CM 4 gr); IgG 3536 mg/dl, cariotype: male with t (9; 22) and Philadelphia chromosome (25%);BCR-ABL: 14,32; bone marrow aspirate: plasmacells 15%;bone marrow biopsy: intermediate-interstitial plasmacytoma, CLL / lymphoma; RMN whole body: hyperintensity at the level of the seventh right rib; PET: osteolytic lesions of the side arch tenth right rib, right iliac bone, left iliac region, right tibia third diaphyseal.RX right hemithorax: osteolytic area at the level of the seventh right rib. So the patient started treatment with Bortezomib, Desamethasone, Alkeran (total 7 cycles).On March 2016, he performed a radiography that showed many osteolytic areas of 45 mm on third distal femur, third proximal and intermediate tibia, third proximal and third distal of fibula.A second PET documented a further MM progression due to new bone localizations and a left tibia biopsy showed localization disease. Radiotherapy colleagues have ruled out the usefulness of a radiation therapy program in consideration of the cerebral damage risk. On June 2016 the patient started a treatment with Lenalidomide for 15 days, interspersed by Glivec, maintaining the disease stable. In September 2017 he developed diplopia and with a nasal surgery, only inflammatory tissue was exported. A revision of the material confirmed plasmacytoma localization. In the same period appearance of a right gluteus sore treated initially with surgical dressing.As blood tests revealed increase of paraprotein levels, bone marrow biopsy resulted negative to myeloma and lymphoma diseases, instead a gluteal skin biopsy revealed plasmacytoma. It was decided to treat cerebral localization due to diplopia and peripherical paralysis. Radiotherapy was started on April 2018 (18 sessions). Bone marrow aspirate test showed plasmacells 15%, BCR-ABL dosage: 213,87, M component increase(5gr), IgG 4440 mg/dl, creatinine and serum calcium: normal. Due to disease progression, a rescue chemotherapy was started according to PAD protocol. After 4 cycles, a bone marrow aspirate documented the presence of plasmacells equal to 80%.The cytogenetic study confirmed the presence of a complex karyotype. So the patient started therapy with Daratumumab, Lenalidomide and Desamethasone which is currently ongoing with an excellent hematological and clinical response Disclosures Ciolli: Janssen: Honoraria; Abbvie: Research Funding.


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