RESUMO
La leucocidina de Panton-Valentine (LPV) es una exotoxina producida por muchas cepas de Staphylococcus aureus, y un importante factor de virulencia. Una infección por S. aureus positivo para LPV deriva en infecciones rápidas y graves de partes blandas y neumonía necrosante en adolescentes sanos, y la tasa de mortalidad es elevada. Presentamos el caso de un paciente de 12 años hospitalizado por fiebre, dificultad respiratoria y coxalgia en el que se identificó neumonía necrosante con embolia pulmonar séptica, absceso del psoas, celulitis y osteomielitis. En el hemocultivo del paciente se aisló S. aureus sensible a la meticilina (SASM) positivo para LPV.
Panton-Valentine leukocidin (PVL) is an exotoxin that is produced by many strains of Staphylococcus aureus, and an important virulence factor. A PVL-positive S. aureus infection leads to rapid and severe infections of soft tissue and necrotizing pneumonia in healthy adolescents, and has a high mortality. This case report included a 12-year-old male patient who admitted for fever, respiratory distress and hip pain and was identified with necrotizing pneumonia with septic pulmonary embolism, psoas abscess, cellulitis and osteomyelitis. The PVL positive methicillin-sensitive S. aureus (MSSA) was isolated in the patient blood culture.
Assuntos
Humanos , Masculino , Criança , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus , Toxinas Bacterianas/análise , Infecções Comunitárias Adquiridas , Exotoxinas/análise , Leucocidinas/análiseRESUMO
Poland syndrome is an uncommon unilateral deformity of chest wall and upper extremity with variable manifestations. Although numerous case reports of Poland syndrome associated with malignancies have been published, intracranial germ cell tumor in Poland syndrome has not been previously reported. The authors describe a 15-year-old male patient with intracranial germ cell tumor and Poland syndrome.
Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Embrionárias de Células Germinativas/diagnóstico , Síndrome de Poland/diagnóstico , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Encefálicas/terapia , Irradiação Craniana , Cefaleia , Humanos , Imageamento por Ressonância Magnética , Masculino , Neoplasias Embrionárias de Células Germinativas/terapia , Síndrome de Poland/terapia , PoliúriaRESUMO
A 15-year-old boy presented to the emergency unit complaining of dyspnea, urticaria and vomiting developed after he fell down when he was playing football. Abdominal ultrasound showed a ruptured hydatid cyst in the right lobe of the liver which was of communicating type. Echinococcus granulosus serologic tests were positive. Medical treatment was started immediately. One week later, follow up US showed no changes in the findings. Intrabdominal fluid leakage was not detected. Patient's general condition showed improvement and he was discharged 12 days later.
Assuntos
Anafilaxia/etiologia , Equinococose Hepática/complicações , Equinococose Hepática/diagnóstico por imagem , Acidentes por Quedas , Adolescente , Anafilaxia/diagnóstico , Anafilaxia/terapia , Animais , Diagnóstico Diferencial , Equinococose Hepática/terapia , Echinococcus granulosus , Humanos , Masculino , Ruptura/diagnóstico por imagem , Ruptura/etiologia , Ruptura/parasitologia , Resultado do Tratamento , UltrassonografiaRESUMO
BACKGROUND AND OBJECTIVE: The purpose of this study was to compare thrombosis rates in antegrade (catheter directed toward the hand) versus retrograde (catheter directed toward the elbow) cannulation of the radial artery. Our secondary objectives were to compare these two techniques in terms of success rate, differences in noninvasive versus invasive blood pressure measurement and complications. METHODS: After obtaining the approval of the local ethics committee and written informed consent, the patients were randomly allocated to the antegrade (group A, n=60) or retrograde (group R, n=60) groups. Arterial thrombosis was evaluated by ultrasonography in each patient. Noninvasive and invasive blood pressure measurements and complications were recorded. Data were analysed using Student's t-test, the Mann-Whitney U-test, the categorical chi test, Fisher's exact test and Bland-Altman analysis. RESULTS: Thrombosis rates were similar between groups. The success rates for cannulation were 86.7 and 96.7% in the antegrade and retrograde groups, respectively (P<0.05). Complication rates were similar between groups. Very significant correlation was observed between the invasive and noninvasive methods when simultaneously measuring arterial systolic, diastolic and mean blood pressure. However, antegrade arterial measurements were consistently lower than those obtained via noninvasive methods. CONCLUSIONS: We conclude that antegrade radial artery cannulation has no advantage over the retrograde approach in terms of reducing thrombosis, but it can be used in cases when the retrograde approach has failed.
Assuntos
Cateterismo , Ponte de Artéria Coronária/métodos , Artéria Radial , Adolescente , Adulto , Idoso , Segurança de Equipamentos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Trombose/diagnóstico por imagem , UltrassonografiaRESUMO
We describe a 5-month old infant who presented with a continuous murmur and enlargement of the left heart. The patient's diagnosis was an anomalous systemic arterial supply to basal segments of the left lower lobe characterized by a lack of a pulmonary arterial supply. This condition was treated without lobectomy. To our knowledge, this report is the first to describe an anomalous systemic arterial supply to basal segments of the lower lobe of the left lung with a single arterial supply that was treated in childhood without lung resection. Our case offers an alternative treatment to surgical lobectomy for this abnormality.
Assuntos
Sopros Cardíacos/etiologia , Sopros Cardíacos/prevenção & controle , Pulmão/irrigação sanguínea , Pulmão/cirurgia , Artéria Pulmonar/anormalidades , Artéria Pulmonar/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Feminino , Humanos , Recém-Nascido , Resultado do TratamentoRESUMO
Most of the extragonadal teratomas are located in the sacrococygeal region. Teratoma with malignant sarcomatous differentiation is a rare form of germ cell tumor. The authors describe a 5-year-old-girl with sacrococygeal teratoma in which sarcomatous elements were observed. The patient was treated with complete surgical excision and adjuvant chemotherapy according to sarcoma protocols.
Assuntos
Região Sacrococcígea , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Teratoma/patologia , Actinas/análise , Pré-Escolar , Terapia Combinada , Dactinomicina/uso terapêutico , Feminino , Humanos , Imageamento por Ressonância Magnética , Sarcoma/diagnóstico , Sarcoma/terapia , Neoplasias de Tecidos Moles/química , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/terapia , Teratoma/química , Teratoma/diagnóstico , Teratoma/terapia , Vimentina/análise , Vincristina/uso terapêuticoRESUMO
Our aim was to assess the effects of initial ultrasonography (US) evaluation on the diagnosis and management of non-traumatic acute abdominal pain in the emergency department. Three hundred patients with the complaint of non-traumatic acute abdominal pain who were sent for US examination with an initial clinical impression were included in the study. Pre-US and post-US surveys were designed for the clinicians who requested US. The percentage concordance of US findings with the discharge diagnosis made by clinical follow-up, imaging modalities and surgery was determined by calculating the confidence interval. The concordance of the initial clinical impression and the US diagnosis with the discharge diagnosis were compared using the McNemar test. US could not detect any pathology in 102 (34%; 95%CI, 28.6-39.3%) of the patients. The US revealed a different diagnosis than the clinical impression in 69 (23%; 95%CI, 18.2-27.7%), and confirmed the diagnosis in 121 (40%; 95%CI, 34.4-45.5%) patients. The US changed the treatment plans in 47% (95%CI, 41.3-52.6%) of the patients. The clinicians stated US helped them "very much" or "moderately" in making a diagnosis in 83% (95%CI, 78.7-87.2%). When US results were compared with the discharge diagnosis, there was concordance in 238 (79.3%; 95%CI, 74.3-83.6%) patients but not in 62 (20.6%; 95%CI, 16-25.1%). Among 121 patients the initial clinical impression agreed with the US diagnosis and there was concordance with the discharge diagnosis in 105 (86.7%; 95%CI, 80-92.7%). The concordance of US findings with the discharge diagnosis was significantly higher than that of the initial clinical impression statistically. In the initial evaluation of the patients with acute abdominal pain, US is considerably helpful in making the correct diagnosis, and that the concordance with the discharge diagnosis is high. When whole abdominal scanning is not performed, targeted US study according to the initial clinical impression decreases the clinical benefit of US.
Assuntos
Abdome Agudo/diagnóstico por imagem , Abdome Agudo/cirurgia , Abdome Agudo/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalos de Confiança , Tomada de Decisões , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ultrassonografia , Adulto JovemRESUMO
Bloody nipple discharge is very rare in childhood. We report the sonographic findings of mammary duct ectasia and cystic changes under the nipple with abnormal content involving a 3-month-old boy with bloody nipple discharge.
Assuntos
Exsudatos e Transudatos/metabolismo , Glândulas Mamárias Humanas/patologia , Mamilos/metabolismo , Ultrassonografia Mamária , Sangue , Humanos , Lactente , Masculino , Mamilos/diagnóstico por imagemRESUMO
Laryngeal, tracheal, and bronchial cartilage calcification is quite rare in children. It was reported to occur in congenital cardiovascular diseases, Keutel syndrome, chondroplasia punctata, warfarin embryopathy, and warfarin sodium therapy. It can occur idiopathically as well. Laryngotracheobronchial cartilage calcification is demonstrated in this report by chest radiography and multiplanar three-dimensional CT examination in a 2.5-year-old boy with nonspecific cough.
Assuntos
Broncopatias/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Doenças das Cartilagens/diagnóstico por imagem , Cartilagens Laríngeas/diagnóstico por imagem , Doenças da Traqueia/diagnóstico por imagem , Humanos , Lactente , Masculino , RadiografiaRESUMO
Hemangioma is a rare tumor of the mediastinum. There are a very small number of patients identified with a combination of mediastinal hemangioma and aortic arch anomaly in the medical literature review. Here we present a fatal case of a 2-month-old female infant having mediastinal hemangioma compressing the trachea accompanied by a right-sided aortic arch with an aberrant left subclavian artery.
Assuntos
Aorta Torácica/anormalidades , Hemangioma/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Malformações Vasculares/diagnóstico por imagem , Obstrução das Vias Respiratórias/etiologia , Evolução Fatal , Feminino , Hemangioma/complicações , Hemangioma/cirurgia , Humanos , Imageamento Tridimensional , Lactente , Neoplasias do Mediastino/complicações , Neoplasias do Mediastino/cirurgia , Radiografia , Artéria Subclávia/anormalidades , Traqueia , Malformações Vasculares/cirurgiaAssuntos
Litíase/diagnóstico , Teratocarcinoma/diagnóstico , Neoplasias Testiculares/diagnóstico , Dor Abdominal/etiologia , Adulto , Humanos , Litíase/complicações , Masculino , Teratocarcinoma/complicações , Teratocarcinoma/cirurgia , Neoplasias Testiculares/complicações , Neoplasias Testiculares/cirurgia , Testículo/diagnóstico por imagem , Testículo/cirurgia , UltrassonografiaAssuntos
Anormalidades Múltiplas/patologia , Articulação Atlantoccipital/anormalidades , Nanismo/patologia , Rim/anormalidades , Osteocondrodisplasias/patologia , Estenose Espinal/patologia , Adolescente , Articulação Atlantoccipital/diagnóstico por imagem , Nanismo/diagnóstico por imagem , Marcha , Humanos , Rim/diagnóstico por imagem , Masculino , Osteocondrodisplasias/diagnóstico por imagem , Radiografia , Estenose Espinal/diagnóstico por imagemRESUMO
Primary vascular leiomyosarcoma is a rare tumor, which arises mainly from the inferior vena cava. Clinical signs are non-specific. Systemic metastasis occurs in the late stage. Imaging with color Doppler ultrasonography, contrast-enhanced computed tomography, or magnetic resonance imaging can significantly contribute to the diagnosis. We present a case of leiomyosarcoma of the inferior vena cava that extended into the right renal vein and the right iliac vein, as it is a rare case and emphasize the significance of the imaging methods in its diagnosis.
Assuntos
Leiomiossarcoma/diagnóstico , Neoplasias Vasculares/diagnóstico , Veia Cava Inferior , Diagnóstico Diferencial , Feminino , Humanos , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/patologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler em Cores , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/patologiaRESUMO
In this case report, a 10-year-old girl with Henoch-Schönlein purpura (HSP) with severe central nervous system involvement and also having familial Mediterranean fever (FMF) is presented.
Assuntos
Febre Familiar do Mediterrâneo/complicações , Vasculite por IgA/complicações , Vasculite do Sistema Nervoso Central/complicações , Vasculite do Sistema Nervoso Central/diagnóstico , Encéfalo/patologia , Criança , Comorbidade , Febre Familiar do Mediterrâneo/diagnóstico , Feminino , Humanos , Vasculite por IgA/diagnóstico , Imageamento por Ressonância Magnética/métodos , Resultado do TratamentoRESUMO
Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon in children and adolescents but occur more frequently in NF1 patients. Angiosarcomatous differentiation in MPNSTs is a rare entity with poor prognosis. We report on a 13-year-old boy with intrathoracic angiosarcoma arising in MPNST associated with NF1.