Untreated plasmacytoma of bone containing macroscopic intralesional fat and mimicking intraosseous lipoma: A case report and review of the literature.

Solitary plasmacytoma is a rare form of plasma cell neoplasm defined by local neoplastic accumulation of monoclonal plasma cells in the absence of systemic proliferative plasma cell disease. In this case report, a 65-year-old female with remote past medical history of papillary thyroid cancer presented with shoulder pain and radiographs showing an aggressive osteolytic lesion presumed to represent an osseous metastasis. The subsequent MRI and CT examinations demonstrated diffuse intralesional macroscopic fat without a nonlipogenic soft tissue component or focal, nodular mass-like enhancement. The presence of macroscopic fat in an untreated osseous lesion suggested a benign lesion with the favored diagnosis an intraosseous lipoma with non-displaced pathological fracture. Therefore, the decision was made to forego image-guided percutaneous biopsy and instead proceed directly to open surgical biopsy and partial distal claviculectomy. Pathology of the resected specimen showed focally dense infiltration of plasma cells within the marrow space and scant hematopoiesis compatible with a plasma cell neoplasm. To the best of our knowledge, this is first case report of solitary plasmacytoma of bone, or any untreated plasma cell neoplasm, containing macroscopic fat upon imaging. The decision to forego image-guided percutaneous biopsy had significant treatment implications as the primary therapy for patients with SPB is not surgical, but localized radiation therapy. Based on this case, solitary plasmacytoma of bone may be included as one of the rare fat containing malignant bone lesions and imaging guided percutaneous biopsy should be considered in symptomatic fat-containing bone lesions.

Multifocal metastatic chordoma to the soft tissues of the fingertips: a case report including sonographic features and a review of the literature.

Chordoma is a rare, locally aggressive tumor which commonly metastasizes, most often to the lung, liver, and spine. In this case report, a 59-year-old male with history of sacral chordoma and pulmonary metastases presented to the emergency department with swelling and discoloration of multiple left fingertips. The initial radiographs led to a presumptive diagnosis of gout, which did not respond to medical therapy. An ultrasound demonstrated multiple solid masses with vascular hyperechoic septations which were subsequently biopsied and proven to be metastatic chordoma. Metastatic disease to the hand is a well documented but rare manifestation of many malignancies. The clinical presentation and radiographic features of multifocal hand metastases may mimic entities such as systemic deposition and granulomatous diseases. To the best of our knowledge, this is the first case report of soft tissue chordoma metastases to the fingertips as well as the first reported sonographic description of chordoma metastases.

Bilateral multifocal lower extremity localized soft tissue amyloidomas: case report with ultrasonographic characterization.

Amyloidosis may be acquired or hereditary and consists of multiple disease processes characterized by the abnormal deposition of extracellular fibrillary protein aggregates. The presentation of amyloidosis is varied, ranging from an isolated, focal deposition to systemic disease. While systemic involvement is common, a rare entity known as amyloidoma or tumor amyloidosis may also occur. The 75-year-old female in this case presented with slowly growing multifocal bilateral lower extremity masses and was ultimately diagnosed with localized amyloidomas in the absence of chronic illness or systemic disease. This case report includes a description of the sonographic features of localized extremity amyloidoma that, to the best of our knowledge, have not yet been described in the literature. Awareness of the sonographic features, and this unique presentation of multifocal soft tissue extremity amyloidomas will allow for this rare diagnosis to be included in a limited differential diagnosis.

CC9 livestock-associated Staphylococcus aureus emerges in bloodstream infections in French patients unconnected with animal farming.

We report 4 bloodstream infections associated with CC9 agr type II Staphylococcus aureus in individuals without animal exposure. We demonstrate, by microarray analysis, the presence of egc cluster, fnbA, cap operon, lukS, set2, set12, splE, splD, sak, epiD, and can, genomic features associated with a high virulence potential in humans.

Language outcomes and service provision of preschool children with congenital hearing loss.

BACKGROUND: Children with congenital hearing loss (HL) are at increased risk of speech and language delays and require increased resource needs. METHODS: Assessments of language, adaptive behavior, and resource needs at mean age of 60±5 months. Effects of age of enrollment in Early Intervention (EI) and degree of HL were evaluated. RESULTS: Children with HL had lower Reynell verbal comprehension scores (77.6±18 versus 94.8±15; p=0.0001) and expressive language scores (85.9±19 versus 97.4±15; p=0.0051) than hearing children. Children with HL enrolled in EI ≤3 months versus >3 months had higher verbal comprehension (86.6±21 versus 70.3±12; p=0.0143) and expressive language scores (92.1±12 versus 80.5±21; p=0.0601), respectively. Children with bilateral moderate to profound HL and children with unilateral or bilateral mild HL were more likely to have low verbal comprehension scores versus children with hearing (75.8±17 and 81.0±22 versus 94.8±15; p=0.001), and receive more special educational services (100% and 100% versus 42%) respectively. After adjusting for degree of HL and Vineland adaptive scores <70, entry to EI ≤3 months was associated with a 13.8 point higher verbal comprehension score (p=0.047) for children with HL. The model accounted for 26% of variance. CONCLUSIONS: Persistent beneficial effects of early age of entry to EI on verbal comprehension scores are observed for children with congenital HL at preschool age. Children with HL continue to need comprehensive education services.

The effects of maternal stress and child language ability on behavioral outcomes of children with congenital hearing loss at 18-24months.

BACKGROUND: Prior studies have shown that children with congenital hearing loss have increased rates of behavior disorders. Child hearing loss has also been reported to be associated with increased maternal stress. Little is known about the behavior or the predictors of behavioral outcomes of children with hearing loss identified early and receiving Early Intervention services. AIM: The objective of this study was to identify the behavioral outcomes in early identified children with hearing loss and control hearing children at 18-24 months of age and to examine the impact of stress on early behavior development. It was hypothesized that children with hearing loss will have more behavior problems, and maternal stress will be associated with child behavior problems. STUDY DESIGN: Prospective observational. SUBJECTS: Children with and without congenital hearing loss and their mothers. OUTCOME MEASURES: The Parenting Stress Index and the Child Behavior Checklist. RESULTS: Children with hearing loss had increased scores for withdrawn and internalizing behavior. In multivariate analyses after adjusting for hearing loss, Neonatal Intensive Care Unit stay, and socioeconomic status, maternal stress independently contributed to higher scores for internalizing behavior, externalizing behavior, and total behavior problems. CONCLUSION: Maternal stress is an important correlate of behavior problems for children with hearing loss and should be considered by Early Intervention providers.

Variable-number tandem repeat analysis and multilocus sequence typing data confirm the epidemiological changes observed with Staphylococcus aureus strains isolated from bloodstream infections.

Since 2000, our geographical region in France systematically surveys bloodstream infections (BSI) due to Staphylococcus aureus. This survey involves 39 health care institutions (HCIs) encompassing 6,888 short-stay beds and was performed during two 3-month periods during 2007 and 2008. The study periods of this survey identified 292 S. aureus isolates causing BSI. Extensive molecular characterization, including genotyping as well as toxin, agr, and staphylococcal cassette chromosome content determinations, allowed us to describe epidemiological evolution in comparison to that discussed in our previous study. Our main epidemiological observation shows that the incidence of BSI remained constant but that methicillin (meticillin)-resistant S. aureus strains with a wider variety of genetic backgrounds now harbor pyl, as has already been reported in different European countries. We noticed stable numbers of BSI episodes involving community-acquired methicillin-sensitive S. aureus (MSSA), whereas a drastic increase in the number of strains harboring the tst gene was recorded. The increase in the number of tst gene-harboring strains is related to known hospital-acquired MSSA isolates and appears related to epidemic episodes in specific HCIs. Monitoring the increase in prevalence of specific strains helps us understand where the standard precautions are not satisfactorily applied or do not efficiently prevent the spread of epidemic MSSA strains in these HCIs. The recent increases in incidence of these strains call for particular vigilance to avoid the spread of potentially virulent MSSA strains harboring the tst gene and for continuance of this strategy of BSI surveillance.

Staphylococcus aureus strains isolated from bloodstream infections changed significantly in 2006.

We studied 358 Staphylococcus aureus strains isolated from bloodstream infections (BSI) observed during an epidemiological study covering 2,007,681 days of hospitalization in 32 healthcare institutions (HCIs) between 2004 and 2006. The strains were tested for antibiotic susceptibility and characterized genetically. The incidence of S. aureus BSI declined regularly through 2004 and 2005 and then significantly increased in 2006 (+80%). This was largely due to an increase in BSI involving methicillin-sensitive S. aureus (MSSA) strains and nonmultiresistant methicillin-resistant S. aureus (NORSA) strains. Ninety-six percent of the NORSA strains were resistant only to methicillin and fluoroquinolones. Most of the MSSA strains belonged to a small number of pulsed-field gel electrophoresis (PFGE) divisions and were associated with epidemic phenomena in HCIs. The NORSA strains also clustered into a limited number of PFGE divisions but could not be related to any local outbreak in HCIs. In 2006, there was a significant increase in the incidence of BSI associated with tst gene-positive MSSA strains (+275%) and the first three BSI associated with tst gene-positive MRSA were observed. PFGE data revealed a limited heterogeneity among the tst gene-positive strains without any outbreak in the HCIs. Our study underlines the need for infection control teams to focus efforts on preventing both MRSA and MSSA BSI. As recently demonstrated in vitro, fluoroquinolones may enhance horizontal transfer of virulence and antibiotic resistance genes. These antibiotics are widely used in France, so our findings raise the issue of whether their use has contributed to the acquisition of mecA and tst genes by S. aureus strains.

Epidemiology and typing of Staphylococcus aureus strains isolated from bloodstream infections.

We carried out an epidemiological study covering 2,365,067 patient days of hospitalization between 2000 and 2003. During this time, 413 Staphylococcus aureus bloodstream infections occurred. This corresponds to 15% of the 2,676 bloodstream infections observed during this period in the 31 hospitals in our region of France, which has 2.5 million inhabitants. The incidence of nosocomial S. aureus bloodstream infections was 0.11 per 1,000 days of hospitalization. The prevalence of methicillin-resistant S. aureus (MRSA) strains, of which 13% were nonmultiresistant MRSA (NORSA), was 33%, and this percentage was stable over the 4 years. In contrast, the prevalence of S. aureus strains susceptible to methicillin but resistant to quinolones or susceptible to methicillin but multiresistant to antibiotics (EMSSA strains) increased from 4% in 2000 to 23% in 2003. As previously reported, MRSA strains were mostly recovered from nosocomial bloodstream infections, whereas NORSA strains-generally considered to be responsible for community-acquired infections-were always isolated from nosocomial bloodstream infections. Pulsed-field gel electrophoresis (PFGE) analysis of 109 MRSA strains and 15 EMSSA strains demonstrated clonal diffusion of the three major French MRSA clones and revealed considerable genetic heterogeneity among EMSSA strains. Although no epidemiologically related NORSA strains clustered in particular PFGE groups, the distribution of MRSA strains isolated from bloodstream infections according to the portal of entry (vascular devices, pulmonary, and urinary) was not random for the major PFGE clones, suggesting that each MRSA lineage displays particular virulence features.

Human monocytes synthesize hyaluronidase.

The involvement of hyaluronic acid (HA) oligosaccharides and blood-derived mononuclear cells in inflammatory processes prompted us to determine whether peripheral blood mononuclear cells (PBMC) possess hyaluronidase activity. PBMC were incubated with macromolecular-tritiated HA at pH 3.8 and supernatants were analysed by size exclusion chromatography to reveal digestion of HA. This digestion was due to the CD14-positive (CD14+), adherent, non-specific esterase-positive, subpopulation of PBMC. Hyaluronidase activity (72 kDa) was found in aqueous and non-ionic detergent PBMC extracts but not in the medium in which the cells had been cultured. These results indicate that hyaluronidase is, at least in part, linked to the membrane rather than excreted. Hence, monocytes have one or more hyaluronidases that can generate a pool of active HA fragments within tissues. Hyaluronidase activity was also found in 3/3 myelomonocytic lineage leukaemias but not in 3/3 lymphoblastic leukaemias.