Necrotizing fasciitis associated with primary cutaneous B-cell lymphoma. A case report.

Necrotizing fasciitis is a rapidly progressive and life-threatening infection of the deeper skin layers and subcutaneous tissues that moves along the facial planes. OBJECTIVES: We present the rare case of a patient with necrotizing fasciitis associated with high malignancy b-cell lymphoma. Our purpose is to investigate the probable connection between the two pathologies and evaluate the importance of early surgical intervention. CASE REPORT: 51-year old Caucasian woman presented at the E.R. with history of a painful left thigh over a week and fever up to 38,4°C over the last three days. Necrosis of the soft tissues and fascial planes were observed clinically. After the initial treatment and due to the patient's multiple organ dysfunction (septic shock), she was transferred to the ICU were she was intubated resuscitated with IV fluids and given IV antibiotics. 24 hours after the admission it was decided that the patient should undergo surgery and an extensive debridement of the necrotic area was performed. The antibiogram of the blood culture revealed streptococcus pyogenes and she was administered penicillin while intubated and monitored in the ICU until the seventh postoperative day. On the eighth post-day she was transferred back to the surgical department, hemodynamically normal and stable. She was discharged one month later and she was referred to a plastic surgery center for the final reconstruction surgery. CONCLUSIONS: This case highlights that the high index of suspicion and the early aggressive surgical intervention seems to be very critical to improve survival of the patients with necrotizing fasciitis.

Well-promising outcomes with vacuum-assisted closure in an infected wound following laparotomy: A case report.

INTRODUCATION: Negative pressure wound therapy (NPWT) represents an alternative method to optimize conditions for wound healing. Delayed wound closure is a significant health problem, which is directly associated with pain and suffering from patient's aspect, as well with social and financial burden. PRESENTATION OF CASE: We report a case of vacuum-assisted wound therapy with hypertonic solution distillation and continuous negative pressure application, in an infected wound after laparotomy for incisional hernia reconstruction with mesh placement. Negative pressure was initiated at the wound margins after failure of conventional treatment with great outcomes, achieving a total closure of the incision within two weeks. DISCUSSION: Each wound has particular characteristics which must be managed. Vacuum assisted closure (VAC) with continuous negative pressure and simultaneous wound instillation and cleanse can provide optimum results, reducing the cavity volume, by newly produced granulated tissue. CONCLUSION: The simultaneous use of instillation and constant pressure seemed to be superior in comparison with NPWT alone. Compared to conventional methods, the use of VAC ends to better outcomes, in cases of infected wounds following laparotomy.

Evaluation of the effect of silicone breast inserts on X-ray mammography and breast tomosynthesis images: A Monte Carlo simulation study.

PURPOSE: Breast augmentation is one of the most popular cosmetic surgeries worldwide. The aim of this study is to investigate the effect of breast implant insertion on the detectability and visibility of lesions on mammography and breast tomosynthesis (BT) images. MATERIALS AND METHODS: Three software phantoms, composed of a homogeneous background with embedded silicone gel structures, and two types of breast abnormalities, microcalcifications (µCs) and masses, were generated. Two X-ray breast imaging modalities were simulated: mammography and BT with six incident monochromatic X-ray beams with energies in the interval between 20 and 30 keV. Projection images were generated using an in-house developed Monte Carlo simulator. The detectability of mammographic findings adjacent to the implant material and the influence of the incident beam energy and implant thickness on the feature detection were studied. RESULTS: It was found that implants thicker than 26 mm for the case of mammography and 14 mm for the case of BT obscured the visibility of underlying structures. Although BT demonstrated a lack of contrast, this modality was able to visualize µCs under considerable depths of implant. Increasing the incident beam energy led to better visualization of small µCs, while in the case of breast masses, their detectability was limited. CONCLUSIONS: Silicone gel implants introduce a limitation in the image quality of mammograms resulting in low detectability of features. In addition, silicone gel implants obscure partially or totally parts of the image, depending on the size and the thickness of the implant as well the energy of the X-rays used.

Advanced Mesodermal (Müllerian) Adenosarcoma of the Ovary: Metastases to the Lungs, Mouth, and Brain.

Background. A malignant mixed Müllerian tumor (MMMT) is a malignant neoplasm found in the uterus, the ovaries, the fallopian tubes, and other parts of the body that contains both carcinomatous (epithelial tissue) and sarcomatous (connective tissue) components. Outcome of MMMTs is determined primarily by depth of invasion and stage. The metastatic background of these lesions is controversial and unknown. Case Report. A 75-year-old woman was admitted to the hospital with anorexia, weakness, and persistent coughing. The imaging exams revealed a solid, promiscuous lesion of 16 × 14 cm in dimensions located into the small pelvis, surrounding the uterus and the ovaries. The patient underwent exploratory laparotomy. The mass was removed and the histological examination of the specimen revealed an advanced mesodermal adenocarcinoma of the ovary (MMMT). Nine days after the operation the patient presented with metastatic lesions in the mouth as well as the lungs. Within a month after the discharge from the hospital metastatic lesions of the MMMT were also depicted in the CT brain scan. Conclusion. Despite the fact that sarcomas have a long-term metastatic potential, to our knowledge this is the first case of Müllerian adenosarcoma presenting with such extraperitoneal metastases.

Detection of cytokeratin-19 mRNA-positive cells in the peripheral blood and bone marrow of patients with operable breast cancer.

BACKGROUND: To compare detection rates and evaluate the clinical relevance of cytokeratin-19 (CK-19) mRNA-positive cells in the peripheral blood (circulating tumour cells, CTCs) and bone marrow (disseminated tumour cells; DTCs) of patients with early breast cancer. METHODS: Paired samples of peripheral blood and bone marrow were obtained from 165 patients with stage I-II breast cancer before the initiation of adjuvant chemotherapy. In 84 patients, paired blood and bone marrow samples were also available after chemotherapy. The detection of CK-19 mRNA-positive CTCs and DTCs was assessed by real-time PCR. RESULTS: CK-19 mRNA-positive CTCs and DTCs were detected in 55.2 and 57.6% of patients before chemotherapy, respectively. After chemotherapy, CTCs and DTCs were identified in 44 (52.4%) and 43 (51.2%) of the 84 patients, respectively. There was a 93.9% (McNemar; P=0.344) and 72.6% (McNemar; P=0.999) concordance between blood and bone marrow samples before and after chemotherapy, respectively. The detection of CK-19 mRNA-positive CTCs or DTCs before chemotherapy was associated with decreased overall survival (P=0.024 and P=0.015, respectively). In addition, their simultaneous detection was also associated with an increased incidence of disease-related death and decreased overall survival (P=0.016). CONCLUSIONS: The detection of CK-19 mRNA-positive CTCs using reverse transcription-PCR (RT-PCR) both before and after chemotherapy is correlated with the detection of CK-19 mRNA-positive DTCs in patients with early-stage breast cancer. The determination of the CTC status by RT-PCR conveys clinically relevant information that is not inferior to DTC status and, owing to the ease of sampling, warrants further evaluation as a tool for monitoring minimal residual disease.

Mild dilatation of renal pelvis in term neonates with urinary tract infection.

The purpose of this study was to assess the incidence and evolution of mild dilatation confined to the renal pelvis in term neonates with urinary tract infection developing within 2 weeks from birth. Twenty-two neonates with mild dilatation of the renal pelvis out of 180 neonates with urinary tract infection were identified giving an incidence of 12.2% for this finding. Male to female ratio was 6.3:1. The left kidney was twice as frequently involved (68 vs. 32%). At follow-up, the dilatation had disappeared in 20 neonates (90.9%) by a mean age of 2.7 years with only one neonate developing two further episodes of urinary tract infection in the infantile period. No other morbidity was noted.

Modulation of 5-ALA-induced PpIX xenofluorescence intensities of a murine tumour and non-tumour tissue cultivated on the chorio-allantoic membrane.

Exogenous administration of 5-aminolaevulinic acid (5-ALA), an early precursor in haem synthesis, induces accumulation of endogenous photo-active porphyrins, particularly protoporphyrin IX (PpIX). Modulation of 5-ALA-induced PpIX-xenofluorescence intensities of a murine tumour and normal (non-tumour) tissue was studied in vivo on the chorio-allantoic membrane (CAM) of fertilized chicken embryos. Tumours were grown from the murine fibrosarcoma cell line SSK II. Murine 3T3 fibroblasts (clone A31) were used for cultivating normal tissue. The autofluorescence and xenofluorescence intensities of 5-ALA-induced PpIX xenofluorescence were compared. After administration of 5-ALA to the CAM inoculated tissues, the SSK II tumours exhibited higher xenofluorescence intensities than the 3T3 tissues. Autofluorescence intensities of both types of tissue were not distinguishable. The effects of several biochemical reagents on the xenofluorescence intensities of the fibrosarcoma and fibroblast tissues were investigated. In both tissue types, the intensities increased after incubation with glucose and antimycin A, while nicotine-adenine-dinucleotide increased the 3T3 fibroblast xenofluorescence more than the SSK II fibrosarcoma xenofluorescence. Incubation with dimethyl sulphoxide (DMSO) attenuated 5-ALA-induced PpIX xenofluorescence, while oxamic acid attenuated the 3T3 fibroblast xenofluorescence more effectively than the xenofluorescence of SSK II fibrosarcoma. Ethanol and 2-iodoacetamide drastically decreased xenofluorescence intensities in both tumour and normal tissue.