Gemcitabine associated pseudocellulitis: A missed diagnosis.

We report a case of a 51-year-old male with past medical history significant for cholangiocarcinoma presented with two weeks of worsening bilateral lower extremity swelling and erythema. Patient has been on active chemotherapy for his cholangiocarcinoma with Gemcitabine weekly infusions. Physical exam was significant for bilaterally petechial rash coalescing into ecchymoses over the dorsum of the feet, sparing soles and toes, which dissipated into thinning petechiae more proximally. On labs he did not have any leukocytosis, his platelet count was 50 × 103/µL and basic metabolic panel was benign. Patient was started on Vancomycin for presumed cellulitis. Lower extremity ultrasound Doppler ruled out deep venous thrombosis. Patient did have biopsies bilaterally on his legs, which showed hypersensitivity reaction consistent with the diagnosis of pseudocellulitis. His Vancomycin was discontinued and his symptoms improved. Our case further supports that pseudocellulitis is underrecognized and underreported, potentially leading to unnecessary antibiotic exposure and unnecessary diagnostic work-up as seen unfortunately in our patient. Unnecessary antibiotic exposure is increasing the risk for clostridium difficile and or antibiotic resistance, therefore awareness of this reaction is critical, as to avoid unnecessary antibiotics, and costly diagnostic workups.

Epidemiology of fall related forearm and wrist fractures among adults treated in US hospital emergency departments.

OBJECTIVE: To examine national estimates of forearm and wrist fractures among adults treated in US emergency departments. METHODS: The National Electronic Injury Surveillance System All Injury Program was used to estimate emergency department visits for unintentional fall related forearm and/or wrist fractures among adults aged 50 years or older between 2001 and 2007. Census population estimates were used as the denominator to calculate age-specific and age-adjusted fracture rates per 100,000 persons. RESULTS: Based on 14,771 cases, an estimated 1,045,008 adults aged ≥50 years were treated in US hospital emergency departments for fall related forearm and/or wrist fractures during the study period. Of these, an estimated 832,591 (80%) fractures occurred among women. The incidence of fractures among women increased gradually with age from the age of 50 years. In men, fracture rates remained low until later in life. Between 2001 and 2007, fracture rates increased predominantly among women in the age group 50-59 years at an annual rate of 3.9% (95% CI -0.1 to 8.2). CONCLUSIONS: The study indicates marked gender differences in unintentional fall related forearm and/or wrist fractures among adults aged ≥50 years treated in US hospital emergency departments. Interventions aimed at preventing falls might be effective in reducing the incidence of this injury, particularly in those women who already have diminished bone mineral.

A Case Report of Cardiac Amyloidosis Highlighting the Importance of Strain Analysis.

Cardiac involvement in light-chain (AL) amyloidosis has a high mortality. Once cardiac symptoms are present, it is important to make a diagnosis as there is an inverse relationship between mortality and time of diagnosis. Echocardiography is usually one of the first tests performed. But strain analysis, which can provide important clues, is not routinely performed. This is a case of AL amyloidosis presenting with heart failure in which echocardiographic strain analysis was vital for its diagnosis.

A Case of Recurrent Coronary Subclavian Steal Syndrome.

Coronary subclavian steal syndrome (CSSS) is one of the rare complications of coronary artery bypass graft surgery (CABG). This phenomenon is a potential complication after left internal mammary artery (LIMA) to left anterior descending artery (LAD) CABG. A proximal stenosis of the left subclavian artery (SA) could cause retrograde flow from LIMA to left SA, which characterizes the mechanism of CSSS. We describe a unique case of recurrent CSSS in a 64-year-old female who presented with one month of exertional dyspnea and acute onset chest pain. She had an extensive coronary artery disease history with CABG 15 years prior to presentation and CSSS treated with left SA stent placement nine years later. She also underwent percutaneous intervention with stents placed in the saphenous vein graft. Although electrocardiogram, cardiac enzymes, and stress test did not show any evidence of acute ischemic changes, perfusion scan detected large areas of partially reversible ischemia. Cardiac catheterization was performed, which showed in-stent restenosis of the left SA and retrograde flow from the LIMA to the left SA indicative of recurrence of CSSS. Left SA arteriogram confirmed in-stent restenosis of the left SA, which was treated with balloon angioplasty and stent placement.

Bortezomib Plus Melphalan-Induced Cardiomyopathy Presenting as Sinus Tachycardia and Systolic Heart Failure.

Chemotherapy-induced cardiotoxicity is a known condition, however, bortezomib and melphalan do not typically cause cardiotoxicity. With the rise in the use of newer chemotherapeutic agents, it is important to identify and understand the cardiac implications of chemotherapeutic agents. We present a case of a 70-year-old female with no known significant cardiac history presenting with partially reversible cardiomyopathy with initial presentation only being as sinus tachycardia.

Reconstrucción temprana en el tórax inestable con sistema de osteosíntesis torácico: Reporte de caso / Early unstable chest reconstruction with thoracic osteosynthesis: A case report

Se presenta el caso de un paciente varón con tórax inestable. Esta lesión es una entidad poco común que puede ser originada por múltiples traumatismos de alto impacto. El diagnóstico se estableció por signos clínicos y estudios de imágenes. El paciente recibió tratamiento quirúrgico con un sistema de osteosíntesis costal (StraCos®); se discuten los resultados obtenidos y sugerencias para casos de este tipo. (AU)

We present the case of a male patient with unstable chest, which is a rare entity that may be caused by high impact trauma. The diagnosis was stablished by clinical manifestations and image results. The patient received surgical treatment with a rib osteosynthesis. We discussed the results obtained and propose suggestions to manage this kind of patients. (AU)

Establecimiento y evaluación del sistema avidin-biotina sobre papel de nitrocelulosa, para el serodiagnóstico de cisticercosis porcina / Establishment and evaluation of avidin-biotin system onto nitrocellulose paper for the serodiagnosis of porcine cysticercosis

Se instrumento una prueba de inmunodot para detectar cerdos con anticuerpos contra Cysticercus cellulosae. El antígeno se preparó a partir de Cysticercus cellulosae diluido en una solución salina de tris (TBS). Se depositaron 10 µl del antígeno sobre papel de nitrocelulosa, el cual fue bloquedo e incubado a temperatura ambiente. El suero fue diluido en una solución de TBS con 7.5 pH, que contenía gelatina y tween 20 y se incubó, posteriormente se anadió un anticuerpo unido a avidina-biotina peroxidasa contra la IgG del cerdo. Al añadir el sustrato, la reacción positiva se manifestó de un color morado oscuro. Al comparar resultados con los obtenidos de la inspección sanitaria post mortem, la prueba de inmunodot obtuvo una concordancia de 95.4 por ciento, sensibilidad de 91.1 por ciento y especificidad de 96.9 por ciento. La prueba descrita es simple, barata y da resultados objetivos en el serodiagnóstico de la cisticercosis porcina