Case Report: Emphysematous Pyelonephritis With a Congenital Giant Ureterocele

A 14-year-old girl noticed malodorous urine and experienced left flank pain. The patient was presented to our hospital with gradually increasing pain. She had no underlying disease but had a history of pain on micturition for several days. Hematologic examination indicated low white blood cell and platelet counts and a high serum lactate level. Computed tomography showed that a part of the parenchyma of the left kidney had poor contrast and was deteriorated, with fluid and gas retention from the perirenal region to the retroperitoneal cavity. A left hydroureter and large ureterocele were observed in the bladder. She was diagnosed with emphysematous pyelonephritis (EPN) with a giant congenital ureterocele. Vasopressors and blood transfusion failed to maintain normal circulatory dynamics, and an open left nephrectomy and transurethral ureterocele fenestration were performed. The excised outer portion of the left kidney was dissolved by the infection and replaced with blood clots and necrotic tissue. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry identified the inflammatory, gas-producing bacteria Actinotignum schaalii, Peptoniphilus asaccharolyticus, and Actinomyces odontolyticus. Meropenem was administered for 4 days postoperatively and then de-escalated to sulbactam/ampicillin for another 10 days. The patient was discharged on day 17 of hospitalization, and the postoperative course remained favorable. EPN is extremely rare in pediatric patients, and it is believed that nephrectomy is sometimes necessary if the patient does not have normal circulatory dynamics despite the use of catecholamines.

Risk Factors of Trauma-induced Thrombotic Microangiopathy-like Syndrome: A Retrospective Analysis

Background: Patients with trauma may develop thrombocytopenia. We encountered cases wherein patients experienced symptoms resembling thrombotic microangiopathies (TMAs) following severe trauma. As the condition of these patients did not comply with the diagnostic criteria of thrombotic thrombocytopenic purpura and there is no mention of trauma among the several causes of TMAs, it was termed as “trauma-induced thrombotic microangiopathy-like syndrome” (t-TMAS). In this study, we aimed to analyze risk factors that may affect the incidence of t-TMAS in patients with severe trauma. Methods: This retrospective study was conducted in the trauma intensive care unit at the Kyungpook National University Hospital between January 2018 and December 2019. The medical records 1164 of the 1392 enrolled participants were analyzed. To assess risk factors of t-TMAS, we analyzed age, sex, mechanism of trauma, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), hematologic examination, and red blood cell (RBC) volume transfused in 24 h. Results: Among 1164 patients, 20 (1.7%) were diagnosed with t-TMAS. The univariate analysis revealed higher age, ISS, and myoglobin, lactate, creatine kinase-myocardial band (on admission), creatine phosphokinase, lactate dehydrogenase (LDH), and lactate (day 2) levels in the t-TMAS group than in the non-t-TMAS group. The RBC volume transfused in 24 h was higher in the t-TMAS group than in the non-t-TMAS group. t-TMAS was more common in patients with injuries in the chest, abdomen, and pelvis (AIS score ≥3) than in those with head injuries (AIS score ≥3) alone. The higher the sum of AIS scores of the chest, abdomen, and pelvis injuries, the higher the incidence of t-TMAS. Multivariate analysis revealed age, ISS, and LDH level (day 2) to be independent predictors of t-TMAS.Conclusions: Trauma surgeons should consider the possibility of t-TMAS if thrombocytopenia persists without any evidence of bleeding, particularly among older patients with multiple severe torso injuries who have high LDH levels on day 2. Early diagnosis and treatment of t-TMAS could improve patients’ prognosis.

Postpartum Thyroiditis: A Case Report

ABSTRACT: Background: Postpartum thyroiditis (PPT) is a thyroid dysfunctionn syndrome which is temporary or permanent that occurs 1 year after giving birth or abortion. The occurrence of postpartum thyroiditis is 5 – 10% of postpartum women in the world. It is caused by an inflammation of the thyroid gland which leads to a destruction of the thyroid follicle and proteolysis of thyroglobulin. Case presentation: A woman, 31 years old, was admitted to the hospital complaining an enlargement on her neck. The patient said her the enlargement keeps getting larger and she also complained a feeling of something stuck in the throat. The patient also complained a hoarse voice. The patient has just given birth of her second child 5 months ago. From a hematologic examination, radiologic, and blood culture, the patient was diagnosed with Postpartum Thyroiditis. The patient was given Euthyrox therapy and will undergo repeated evaluation after 1 months of the therapy. Conclusion: We reported a case of Postpartum Thyroiditis that was treated comprehensively, and showed a good prognosis.

The Method of Total Erythrocyte and Leukocyte Counting in Raptors at Wildlife Rescue Centre (WRC) Jogja

Most of raptor species rehabilitated for conservation purpose at WRC Jogja are eagles. Annually, we perform general raptor examination involving conventional routine hematologic examination. However, low sample quality and over dense blood cell population during total erythrocyte and leukocyte counting were deemed as obstacles. This study aimed to give wider insight in how total erythrocyte and leukocyte counting was performed at WRC Jogja to overcome those obstacles. Firstly, handling and restraint were done physically adapting the Aba method. One-to-two half millilitres of blood was collected from the ulnar vein using 3-ml-syringe with 24-gauge-needle which was then preserved in an EDTA-containing tube and proceeded to subsequent method no more than 3 hours after collection. No hypovolemic shock was observed. During total erythrocyte and leukocyte counting using Neubauer-ruled counting chamber, we modified the dilution factor to be 250-fold and 50-fold respectively. This method yielded a countable cell density and can be applied in other species in similar condition.

A nomogram prediction model for lymph node metastasis in endometrial cancer patients

Background: The determination of lymph node(LN) status is critical for evaluating prognosis and identifying the necessity of adjuvant therapy of endometrial cancer(EC) patients. However, the significance of systematic lymphadenectomy remains controversial. This study aimed to explore the risk factors for lymph node metastasis(LNM) in patients with EC and develop a clinically useful nomogram based on clinicopathological parameters to predict it.Methods: A total of 1517 consecutive patients who underwent staging surgery for EC were abstracted from Qilu Hospital of Shandong University. Parameters including patient-related, tumor-related, and preoperative hematologic examination-related were analyzed by univariate and multivariate logistic regression to determine the correlation with LNM. Based on the multivariate results, a nomogram was constructed and underwent further validation to predict the probability of LNM.Results: The nomogram was constructed and incorporated valuable parameters from the final multivariate model including histological type, histological grade, depth of myometrial invasion, LVSI, cervical involvement, parametrial involvement, and HGB levels. The nomogram was cross-validated internally by the 200 bootstrap sample and showed good discrimination accuracy with an AUC of 0.899.Conclusions: We developed and validated a 7-variable nomogram with a high concordance probability to predict the risk of LNM in patients with EC.

A Rare Case of Plasma Cell Gingivitis with Cheilitis

Background. Plasma cell gingivitis (PCG) is a rare condition of the gingiva, characterized histopathologically by infiltration of plasma cells in connective tissue. Hypersensitivity reaction due to antigen is considered as primary etiological factor. Case Presentation. The present case is of an 18-year-old male patient suffering from gingival enlargement along with cheilitis. Histopathological and immunohistochemistry of tissue revealed lesion as plasma cell gingivitis. After gingivectomy, the follow up of the patient was done for 8 months. Gradual reduction of lip swelling was observed after gingivectomy during subsequent visits. Conclusion. Early diagnosis is essential as plasma cell gingivitis has similar pathologic changes seen clinically as in leukemia, multiple myeloma, discoid lupus erythematosus, atrophic lichen planus, desquamative gingivitis, or cicatricial pemphigoid which must be differentiated through hematologic examination.

A korai/praefibroticus primer myelofibrosis kivizsgálása és kezelése egy eset kapcsán

Moderate thrombocytosis can accompany several diseases (bleeding, inflammation, iron deficiency, or autoimmune diseases), but hematologic examination is strongly recommended in a patient with persistent platelet count above 450 G/L unless reactive origin can be confirmed. The 47-year-old woman’s medical history included hypertonia, asthma bronchiale, and endometriosis. In March 2015, she underwent laboratory examination due to weight loss and lack of appetite. Her results showed elevated thrombocyte count (617 G/L), but no iron deficiency. She presented in our clinic on 07. 04. 2015 with acute pain below her left hypochondrial region, but simple imaging examinations showed no difference to explain it. Abdominal CT revealed a 4.5 cm thrombus which protruded into the left renal artery, blocking it. We started APTI- (activated partial thromboplastin time) monitored continuous intravenous treatment with unfractionated heparin. The JAK2V617F mutation analysis came back positive. Subsequent bone marrow examination revealed prefibrotic/early stage myelofibrosis, prompting treatment with hydroxyurea. The applied treatments led to the disappearance of the patient’s symptoms accompanied by the gradual normalisation of the thrombocyte count. Moderate thrombocytosis is often secondary, but if it persists and is accompanied by mainly thromboembolic events, the risk of diseases of the haematopoietic system, primarily Philadelphia chromosome negative chronic myeloproliferative disease should also be considered. Clinically, essential thrombocythaemia and the prefibrotic/early stage of myelofibrosis can be very similar. Differential diagnosis is only possible through the histological examination of the bone marrow, which becomes indispensible due to the difference in prognosis and treatment options. Orv Hetil. 2018; 159(15): 603–609.

Acute Phase Response in Enzootic Bovine Leukosis

In the present study, we evaluated acute phase response by detecting haptoglobin (Hp), serum amyloid A (SAA) and fibrinogen in cattle with enzootic bovine leukosis (EBL). A total of 60 Holstein cattle (≤3 years old), comprisingof 40 cattle infected with BLV, and 20 BLV-free healthy controls were enrolled in this study. Diagnosis of the BLV infection was performed by serology (ELISA and AGID) and PCR techniques. APPs were detected by commercial ELISA test kits using validated standard procedures as instructed. All the BLV-infected cattle were in good general health and had normal respiratory rates, pulse rates, body temperatures. However, 5 cattle had enlarged, hard, painless, movable superficial lymph nodes in infected group. APPs including Hp (p<0.001), fibrinogen (p<0.001), and SAA (p<0.05) concentrations were significantly higher in cattle with EBL compared to BLV-free cattle. On hematologic examination, total leukocyte, lymphocyte and granulocytes concentrations were significantly higher in infected cattle when compared tocontrols. In addition, Hp and SAA (p<0. 001) concentrations were significantly higher in symptomatic cattle than asymptomatic. The Pearson correlation revealed significant associations between APPs and total leukocyte and granulocytes; however, there was no correlation with lymphocyte. In conclusion, the results of this study showed increased acute phase response in BLV infected cattle.

Acute Phase Response in Enzootic Bovine Leukosis

In the present study, we evaluated acute phase response by detecting haptoglobin (Hp), serum amyloid A (SAA) and fibrinogen in cattle with enzootic bovine leukosis (EBL). A total of 60 Holstein cattle (≤3 years old), comprising of 40 cattle infected with BLV, and 20 BLV-free healthy controls were enrolled in this study. Diagnosis of the BLV infection was performed by serology (ELISA and AGID) and PCR techniques. APPs were detected by commercial ELISA test kits using validated standard procedures as instructed. All the BLV-infected cattle were in good general health and had normal respiratory rates, pulse rates, body temperatures. However, 5 cattle had enlarged, hard, painless, movable superficial lymph nodes in infected group. APPs including Hp (p<0.001), fibrinogen (p<0.001), and SAA (p<0.05) concentrations were significantly higher in cattle with EBL compared to BLV-free cattle. On hematologic examination, total leukocyte, lymphocyte and granulocytes concentrations were significantly higher In infected cattle when compared to controls. In addition, Hp and SAA (p<0. 001) concentrations were significantly higher in symptomatic cattle than asymptomatic. The Pearson correlation revealed significant associations between APPs and total leukocyte and granulocytes; however, there was no correlation with lymphocyte. In conclusion, the results of this study showed increased acute phase response in BLV infected cattle.