Spontaneous Chest Abscess Caused by Salmonella Enterica subsp. Arizonae in the Desert Southwest; A Case Report and Review of the Current Literature.

Salmonella enterica subspecies arizonae is a rare pathogen but has been reported in the literature in immunosuppressed and rarely immunocompetent patients. Most disease states have been reported in animals and reptiles. Human exposure has resulted in a range of complications from skin and soft tissue infections to bacteremia and periprosthetic joint infections. Predisposing factors such as age, comorbidities, and use of Mexican folk healing practices increase the risk of developing an infection. S. arizonae has been associated with gastrointestinal infections in several parts of the country and on rare occasions have been isolated from skin and soft tissues, prosthetic joints, and empyema. Case: This is a unique case of a large de novo chest abscess that developed in a 59-year-old diabetic male from the Southwest region with cultures growing Salmonella enterica subspecies arizonae. This patient presented without predisposing factors and did not appear to be ill at the time of admission. He was treated successfully by aspirating the abscess along with a 2-week course of ceftriaxone intravenously.

Chest Radiographs for Distinguishing ADA-SCID from Other Forms of SCID.

PURPOSE: Early differentiation of adenosine deaminase deficient severe combined immunodeficiency (ADA-SCID) from other forms of SCID may initiate appropriate treatment interventions with the aim of metabolic detoxification and improved outcome. Our hypothesis was that previously described radiological features (inferior scapular angle squaring and spurring and costochondral cupping) can differentiate ADA-SCID from other forms of SCID. METHODS: Chest radiographs at clinical presentation between 2000 and 2017 of children with ADA-SCID were retrospectively included, provided that the radiological features were assessable. Random chest radiographs of children with other forms of SCID were included for comparison. Three paediatric radiologists (2 senior, 1 junior) assessed the radiographs for the specific radiological features and stated their diagnosis (ADA-SCID or non-ADA-SCID). An optimal threshold for test performance was defined using a ROC curve. RESULTS: Thirty-six patients with ADA-SCID and twenty-five patients with non-ADA-SCID were included (median age 3.8 months). The optimal threshold for test performance was at approximately < 7 months old: sensitivity 91.7%, specificity 80.7%, interreader agreement was k = 0.709, AUC 0.862. The positive likelihood ratio for scapular squaring, scapular spur, and costochondral cupping was 4.0, 54.6 and 7.8, respectively. The test was valid when performed by both senior and junior paediatric radiologists. CONCLUSION: Radiological features such as scapular spurring, scapular squaring and costochondral cupping can reliably differentiate between ADA-SCID and other forms of SCID. This is true for children aged approximately < 7 months, and this is reliable when assessed by both senior and junior paediatric radiologists.

Mycobacterium abscessus subsp. abscessus empyema complicated with subcutaneous abscess.

There have been no case reports of thoracic subcutaneous abscess after surgery for Mycobacterium abscessus complex associated empyema. We herein report a case of Mycobacterium abscessus subsp. abscessus (M. abscessus subsp. abscessus) induced subcutaneous abscesses following surgical treatment for concurrent M. abscessus subsp. abscessus -associated empyema and pneumothorax. A 75-year-old woman had M. abscessus subsp. abscessus -associated empyema and pneumothorax. She underwent surgical treatment of decortication and fistulectomy and suffered from M. abscessus subsp. abscessus -associated subcutaneous abscesses after thoracentesis/drainage. A multidisciplinary approach combined with surgical care, thermal therapy, and multidrug chemotherapy contributed to a successful result. An early multidisciplinary approach is believed to be important in cases of M. abscessus subsp. abscessus -associated empyema and subcutaneous abscess.

Practice Patterns of Thoracic Radiotherapy for Extensive-Stage Small-Cell Lung Cancer: Survey of US Academic Thoracic Radiation Oncologists.

PURPOSE: Despite the recent CREST trial demonstrating a survival benefit to thoracic radiotherapy (TRT) for patients with extensive-stage small-cell lung cancer (ES-SCLC) with response to chemotherapy, as well as endorsement by current National Comprehensive Cancer Network guidelines, TRT may not be uniformly delivered in clinical practice across all circumstances. METHODS AND MATERIALS: We surveyed US academic thoracic radiation oncologists regarding their practice patterns for TRT and assessed conditions in which withholding TRT could be warranted. A 27-question survey of demographics and practice patterns, including 5 clinical cases, was sent to 111 physicians. RESULTS: Response rate was 39% (43/111). Among respondents, 60% have at least 6 years of work experience following residency; 77% and 71% respectively see > 50 lung cancer and > 11 SCLC cases annually. Regarding practice patterns, 74% use TRT in 26% to 75% of patients with ES-SCLC. Respondents would withhold TRT in cases with Eastern Cooperative Oncology Group performance status ≥ 3 (91%), when pulmonary function necessitates continuous oxygen via nasal cannula (62%), for postchemotherapy tumor progression (58%), and if > 4 postchemotherapy extrathoracic metastases were present (58%). The 5 clinical cases highlighted practice variability, although 1 case had 100% agreement among respondents. CONCLUSIONS: Despite support of TRT administration from the CREST trial, there are several conditions associated with frequently withholding TRT. The most common reasons include performance status, postchemotherapy extent of disease, and pulmonary function; age and prechemotherapy extent of disease were least associated. Further research should aim to identify which subgroups of ES-SCLC benefit most from TRT.

Hypereosinophilic syndrome presenting with multiple organ infiltration and deep venous thrombosis: A case report and literature review.

BACKGROUND: Hypereosinophilic syndrome (HES) can be fatal, particularly when eosinophils infiltrate vital organs and/or if extensive thrombosis develops. However there are no standard recommendations for the use of anticoagulant therapy of HES in the setting of thrombosis. METHODS: We herein present a case of a 46-year-old female who presented with marked peripheral eosinophilia with symptoms of multi-organ infiltration and extensive deep venous thrombosis (DVT). In this case, evaluation was carried out before the diagnosis was established, and timely standard-dose corticosteroids combined with a new oral anticoagulant (NOAC) therapy were carried out. RESULTS: These measures resulted in a rapid response and long-term disease control. CONCLUSION: Although there are no data to support which anticoagulant is preferred in this setting, this case indicates that the new oral anticoagulants may play an important role in the treatment of thrombosis in HES.

Evaluation of the Safety and Efficacy of a Low Fluence, Picopulsed, Alexandrite Laser in a Pico-Toning Technique With a Diffractive Lens Optic for the Treatment of Photodamage and Textural Improvement in "Off the Face" Applications.

BACKGROUND: The diffractive optic coupled with a picosecond pulsed alexandrite laser has been shown to effectively minimize pigmen- tation while improving the appearance of textural irregularities and rhytides. We evaluated the safety and ef cacy of the diffractive optic laser treatment for off of the face applications including the hands and décolletage in a pico-toning technique. STUDY: 20 healthy female patients (40-70 years of age) were treated with a picosecond pulsed alexandrite laser with a diffractive lens. 10 of the patients were enrolled in a prospective hand assessment study (20 hands) while the remaining 10 subjects were enrolled in an IRB approved study treating photodamage of the décolletage. Protocol for both groups included 4 treatments to the designated area with a picopulsed alexandrite laser with a diffractive lens on a 6mm handpiece delivering 0.71 j/cm2 with 10 hz repetition at 3 week intervals (+- 7 days) with follow up at 1 month and 3 months post fourth treatment using standardized digital photography. RESULTS: Statistically signi cant improvement in the overall appearance of pigmentation, texture and rhytides were recorded at each sub- sequent visit and at 1 and 3 months post the nal laser treatment. Clinical photographs were evaluated from baseline to the final photo at 3 months post last laser treatment by the treating physician, patient, and an independent evaluator. All hand subjects and chest subjects showed improvement in all 3 areas which were found to be statistically signi cant. No adverse events occurred in either study group. CONCLUSION: These study results show signi cant improvement in not only pigmentation, but in texture and rhytides in all subjects receiving pico-toning laser treatments to off of the face areas. The laser was well tolerated by all patients with no adverse effects. The use of a diffractive lens optic on a 6 mm xed spot size handpiece with a picopulsed alexandrite laser, in a pico-toning technique, provides a safe, low uence, yet effective treatment for not only pigment dyschromia but also textural irregularities and rhytides when treating the hands and décolletage. J Drugs Dermatol. 2016;15(11):1398-1401..

An Internet misadventure: bloodroot salve toxicity.

INTRODUCTION: Bloodroot (Sanguinaria canadensis) is a perennial flowering plant native to North America. Sanguinarine, a benzylisoquinoline alkaloid, is a powerful escharotic contained in the root. Herbalists prescribe bloodroot for multiple conditions including skin lesions and sore throats. We report 2 patients who treated skin lesions with bloodroot to untoward effect. CASE REPORT 1: A 53-year-old man with unremarkable medical history developed a 5-mm papule on his chest that gradually blackened. The patient searched the Internet for "herbal cures" and found bloodroot salve as a therapy for skin lesions. The patient applied bloodroot black salve for 10 days. After 6 months the remaining lesion resumed increasing in size. The patient restarted bloodroot treatments despite intense pain. After 6 weeks the lesion doubled, became ulcerated and purulent, prompting presentation to the Emergency Department. Pathological examination of the lesion revealed malignant melanoma. CASE REPORT 2: A 42-year-old man with a history of metastatic colon cancer developed palpable subcutaneous nodules on the anterior abdominal wall. The patient's mother searched the Internet for cancer salves and purchased black and yellow bloodroot salve. After 8 days, feces were noted discharging from an ulcer where the salve was applied. The patient was admitted for total parenteral nutrition until the enterocutaneous fistula healed. DISCUSSION: Bloodroot is widely available on the Internet and easily purchased. Web sites discuss the efficacy of bloodroot in treating skin cancer. The cases describe attempts to self-treat skin lesions with unregulated Internet therapy. Lack of regulation of information on the Internet allows alternative therapies to be promoted without full consideration of potential toxicity. Greater awareness of agents with such potential for danger needs to be available to health care providers, and the taking of such remedies should always be discussed with the supervising physician.

Use of a collagen-glycosaminoglycan copolymer (Integra) in combination with adjuvant treatments for reconstruction of severe chest keloids.

BACKGROUND: Keloids occurring on the chest can be deforming with significant painful sequelae for patients. These lesions can pose a therapeutic dilemma for the dermatologic surgeon as certain excision defects may be too large to close primarily and recurrences tend to be high (40-100%). A collagen-glycosaminoglycan copolymer (Integra) has been found to be useful in the surgical treatment of scar excisions as the bovine collagen and glycosaminoglycans provide a template for neocollagenesis. Additionally, this dermal regeneration template concomitantly reduces tensile forces on the wound. METHODS: The authors' group has followed five patients with chronic chest keloids refractory to myriad of interventions and treated these patients with surgical excision followed by Integra placement into the wound bed on the chest. Split-thickness grafts were applied shortly thereafter. Patients were followed at regular intervals and all patients received adjuvant therapy with single-dose radiation and intralesional chemotherapy (triamcinolone and/or 5 fluorouracil). RESULTS: This treatment protocol has provided a cure rate of 100% over an average of 43 months follow-up. The symptoms often accompanied by these chest keloids also appear to improve. CONCLUSION: The authors believe that this study provides the groundwork for further investigation of Integra for surgical management of keloids. A placebo-controlled study should be performed to adequately determine if this data holds true.

Effect of hyperbaric oxygen therapy on the duration of treatment of spinal tuberculosis.

The aim of this retrospective study was to investigate the effect of adjuvant hyperbaric oxygen (HBO) therapy on the duration of antibiotic treatment and rate of radiological improvement in the management of spinal tuberculosis. We reviewed a total of 51 patients with tuberculous spondylitis of the spine who were treated by percutaneous abscess drainage or radical surgical debridement with chemotherapy, and of whom 16 randomly selected patients also received adjuvant HBO therapy and 35 did not. Serological markers were monitored in the course of treatment. Percutaneous needle biopsy was performed on each patient before treatment. Spine and chest radiographs, CT scans and MRI were performed. Infection control was achieved in all patients and no recurrence occured. To our knowledge this is the first reported series of patients with spinal tuberculosis treated with HBO therapy as an adjunct to antituberculous chemotherapy. This combination provided earlier clinical and radiologic improvement than chemotherapy alone.

Dietary flaxseed prevents radiation-induced oxidative lung damage, inflammation and fibrosis in a mouse model of thoracic radiation injury.

Flaxseed (FS) has high contents of omega-3 fatty acids and lignans with antioxidant properties. Its use in preventing thoracic X-ray radiation therapy (XRT)-induced pneumonopathy has never been evaluated. We evaluated FS supplementation given to mice given before and post-XRT. FS-derived lignans, known for their direct antioxidant properties, were evaluated in abrogating ROS generation in cultured endothelial cells following gamma radiation exposure. Mice were fed 10% FS or isocaloric control diet for three weeks and given 13.5 Gy thoracic XRT. Lungs were evaluated at 24 hours for markers of radiation-induced injury, three weeks for acute lung damage (lipid peroxidation, lung edema and inflammation), and at four months for late lung damage (inflammation and fibrosis). FS-Lignans blunted ROS generation in vitro, resulting from radiation in a dose-dependent manner. FS-fed mice had reduced expression of lung injury biomarkers (Bax, p21 and TGF-beta1) at 24 hours following XRT and reduced oxidative lung damage as measured by malondialdehyde (MDA) levels at 3 weeks following XRT. In addition, FS-fed mice had decreased lung fibrosis as determined by hydroxyproline content and decreased inflammatory cell influx into lungs at 4 months post XRT. Importantly, when Lewis lung carcinoma cells were injected systemically in mice, FS dietary supplementation did not appear to protect lung tumors from responding to thoracic XRT. Dietary FS is protective against pulmonary fibrosis, inflammation and oxidative lung damage in a murine model. Moreover, in this model, tumor radioprotection was not observed. FS lignans exhibited potent radiation-induced ROS scavenging action. Taken together, these data suggest that dietary flaxseed may be clinically useful as an agent to increase the therapeutic index of thoracic XRT by increasing the radiation tolerance of lung tissues.

Radiographic findings of screening chest films in Priest Hospital.

OBJECTIVE: To study radiographic findings in abnormal chest films from screening programs as part of a Sustained and Holistic Health Care in Priests and Novices in Commemoration of His Majesty the King's 60 Years Accession to the Throne MATERIAL AND METHOD: A retrospective, descriptive study of chest x-ray findings in phase l of the screening of chest film program was performed between February 2006 and June 2006. RESULTS: One thousand one hundred twenty two cases participated in phase l of the screening program. Nine hundred and three cases had a chest x-ray. One hundred thirty one cases had abnormal chest film from radiographic reports. The age range was 17-92 years, with mean age of 42.69 years. The abnormalities found were classified into abnormal heart size in 34 cases (25.95%), pulmonary lesions in 80 cases (61.07%), pleural lesions in 7 cases (5.34%) and other abnormality in 10 cases (7.64%). CONCLUSION: The result of abnormality that was detected from chest films, frontal PA view, was about 14.51%. However, the authors cannot assume that the cases that have a normal chest film are the healthy group. Therefore, a physical and laboratory examinations are a useful combination to classify cases in healthy, asymptomatic, or symptomatic group. In the asymptomatic cases, the results are useful for early detection and treatment. The early diagnosis can improve the result of the treatment and quality of life. This study will be useful for other epidemiology and clinical study.

Biopsia selectiva del ganglio centinela en el tratamiento del melanoma / Sentinel lymph node biopsy in the treatment of melanoma

Introducción. El objetivo del presente estudio es valorar los resultados obtenidos con la aplicación de la técnica de biopsia selectiva de ganglio centinela (BSGC) en el tratamiento del melanoma. Pacientes y método. Estudio clínico prospectivo. Se practicó BSGC a los melanomas primarios con espesor de Breslow mayor de 1 mm, o factores de mal pronóstico asociados. Desde marzo de 2000 a diciembre de 2001 se valoraron 53 melanomas. Resultados. Se realizó BSGC en 37 casos, el 69,8 por ciento de los melanomas. Se obtuvieron 36 mapas linfáticos (97,3 por ciento de las gammagrafías efectuadas) y se practicaron 45 biopsias ganglionares, debido a que en 9 casos (25 por ciento) se obtuvo drenaje a dos territorios. Se obtuvieron metástasis en el ganglio centinela en tres pacientes (8,3 por ciento). En estos casos se realizó linfadenectomía regional, en dos de ellos se halló afección en el resto de la cadena, y en el tercer caso el centinela era el único ganglio afectado. Conclusiones. El 8,3 por ciento de los pacientes a los que se detectó afección metastásica ganglionar se benefició del tratamiento complementario, lo que unido a la casi nula morbilidad hace que la BSGC sea una técnica que debería ser estandarizada en todos los centros donde sea realizable y que atiendan esta patología. (AU)

Hernias de Morgagni. presentación de una serie de casos tratados en la era prelaparoscópica / Morgagni's hernias. Presentation of a series of cases treated in the prelaparoscopic era

Material y método. Revisión de hernias de Morgagni intervenidas en tres hospitales entre los años 1980 y 2000.Resultados. Se recogieron 28 casos, y la proporción varones/mujeres era de 12/16. La edad media fue para los varones de 45 ñ 13,2 (rango: 7-83) y para las mujeres de 51 ñ 16,4 (rango: 18-85) años. Los hallazgos fueron casuales en 13 casos y sintomáticos en 15 ocasiones: cuadros digestivos inespecíficos (n = 8), respiratorios (n = 5) y cardíacos (n = 2). Siete casos fueron intervenidos por vía torácica. En 19 ocasiones el abordaje fue abdominal y en dos, mediante laparoscopia. Se han observado 6 recidivas (21,4 por ciento).Conclusiones. Las hernias de Morgagni son poco frecuentes. Existe riesgo elevado de recidiva tras el tratamiento tradicional. La mayoría se trataron de forma electiva y por abordaje abdominal. (AU)

El interpolador de alto orden: un medio para incrementar la resolución de las imágenes pulmonares obtenidas mediante tomografía computarizada espiral / The high-grade interpolator: a means for enhancing the resolution of helical computed tomography images of the lung

Objetivos: Nuestro trabajo pretende demostrar que la aplicación de un interpolador de alto orden en la reconstrucción de las imágenes torácicas aumenta la resolución, independientemente del filtro de alta resolución. Material y métodos: Ocho observadores separados en dos grupos (de expertos y de inexpertos) valoraron (en dos lecturas separadas en el tiempo) la misma sección torácica reconstruida cuatro veces (st-st, st-xs, b-st, b-xs), combinando los filtros (estándar-st y alta resoluciónb) y los interpoladores (estándar-st y alto orden-xs). Clasificaron las imágenes de más a menos según la resolución percibida. Los resultados se utilizaron para comparar tanto el grado de resolución introducido por el interpolador y el filtro, como la existencia o no de variabilidad entre observadores y entre sus propias observaciones, influida o no por la experiencia. Resultados: Seis de los ocho observadores clasificaron la imagen b-xs como la de mayor resolución en la mayoría de las ocasiones. En segundo lugar se clasificó la imagen b-st. En tercero la imagen st-xs. En último lugar la imagen st-st. Los otros dos observadores (uno entre los expertos y otro en los inexpertos) difirieron sólo en el orden de las imágenes st-xs y b-st, que fueron clasificadas en segundo y tercer lugar respectivamente. El grupo de expertos no mostró variabilidad intraobservador aunque sí dos de los inexpertos. Conclusiones: El interpolador de alto orden aumenta la resolución de las imágenes torácicas, independientemente de quien las evalúe, sin un aumento importante del ruido. Este hecho hace aconsejable su uso en las exploraciones torácicas con TC espiral (TCE). (AU)

Hematoma subdural intracraneal bilateral en un paciente con leptospirosis / Bilateral intracranial subdural hematoma in a patient with leptospirosis

Presentamos el caso de un varón de 39 años de edad, que en el curso de una leptospirosis grave, con fracaso renal agudo, edema agudo de pulmón e ictericia importante, comienza con manifestaciones clínicas de afección neurológica (cefalea, disartria y paresia de la extremidad superior derecha). Se evidencian en tomografía computarizada (TC) y resonancia magnética (RM) hematomas subdurales múltiples y bilaterales. Leptospira puede producir una vasculitis difusa con lesión capilar, dando lugar a distintas manifestaciones hemorrágicas, concretamente en el sistema nervioso es una causa conocida de hemorragia subaracnoidea; el hematoma subdural intracraneal representa un hallazgo no descrito en la bibliografía revisada (AU)

Hiperplasia nodular linfoide en un paciente con inmunodeficiencia combinada grave / Lymphoid nodular hyperplasia in a patient with severe combined immunodeficiency disease

Describimos un caso de hiperplasia nodular linfoide en el contexto de un cuadro de inmunodeficiencia combinada grave. La paciente refería estreñimiento y crisis de dolor abdominal, presentando en la exploración una voluminosa masa abdominal. Los exámenes radiológicos iniciales hicieron sospechar el diagnóstico, pero fue necesaria la realización de una biopsia intestinal con el fin de descartar una afectación linfomatosa. Queremos llamar la atención sobre la semiología radiológica de esta entidad, que si bien en principio puede ser un hallazgo casual sin significado patológico, requiere una especial atención especialmente en sujetos inmunodeficientes (AU)

Leptospirosis hemorrágica pulmonar / Hemorrhagic pulmonary leptospirosis

La leptospirosis es una enfermedad infecciosa característica de países orientales húmedos. La incidencia en países occidentales es relativamente infrecuente. La enfermedad suele manifestarse de dos formas clínicas principales: la hepato-renal y la pulmonar, generalmente con cierto grado de solapamiento entre ambas.Presentamos un paciente con una presentación severa de leptospirosis hemorrágica pulmonar que en el curso de la enfermedad, presentó un cuadro de embolismo multisistémico (bazo, riñón y sistema nervioso central -SNC-). (AU)