Assuntos
Dor Abdominal , Colectomia/métodos , Colo , Corpos Estranhos , Ileostomia/métodos , Perfuração Intestinal , Laparotomia/métodos , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Adulto , Colo/diagnóstico por imagem , Colo/lesões , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Corpos Estranhos/diagnóstico , Corpos Estranhos/fisiopatologia , Corpos Estranhos/cirurgia , Migração de Corpo Estranho/complicações , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino , Cavidade Peritoneal/patologia , Resultado do TratamentoRESUMO
Juvenile xanthogranuloma is a benign histiocytic cell proliferative disorder that occurs in early childhood. The most common presentation occurs within the first 2 years of life with papular or nodular changes to the skin on the head, neck or upper trunk. This case study documents the findings and treatment of a single solitary soft tissue mass in the forefoot of a 17-year-old patient. Unique to this case, the initial diagnosis of tuberous xanthoma was made and, with referral to an outside hospital, changed to a juvenile xanthogranuloma. In addition, unlike most juvenile xanthogranulomas in the literature, there was no superficial dermatological abnormality seen clinically. This change was not a dramatically different diagnosis, but further immunohistochemical staining was necessary for ultimate diagnosis. The soft tissue mass was self-contained to the deeper tissue layers and not the epidermis. The patient was followed for 12 months for possible recurrence and medical workup, without postoperative complications. The purpose of this study was to report on a unique finding and presentation of a xanthogranulomatous soft tissue mass in the forefoot of a pediatric patient.
Assuntos
Xantogranuloma Juvenil , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Pé , Humanos , Recidiva Local de Neoplasia , Pele , Xantogranuloma Juvenil/diagnóstico por imagem , Xantogranuloma Juvenil/cirurgiaRESUMO
OBJECTIVE: In 2013, the American College of Rheumatology (ACR) participated in the Choosing Wisely campaign and devised a recommendation to avoid testing antinuclear antibody (ANA) subserologies without a positive ANA and clinical suspicion of disease. The goals of our study were to describe ANA and subserology ordering practices and predictors of ordering concurrent ANA and subserologies in a safety-net hospital. METHODS: We identified ANA and subserologies (dsDNA, Sm, RNP, SSA, SSB, Scl-70 and centromere) completed at Denver Health between 1/1/2005 and 12/31/2011. Variables included demographics, primary insurance, service, and setting from which the test was ordered. We performed multivariable logistic regression to determine predictors of concurrent ordering of ANA and subserologies. RESULTS: During seven years, 3221 ANA were performed in 2771 individuals and 211 (6.6%) were performed concurrently with at least one subserology. The most common concurrent subserologies were dsDNA (21.8%), SSA (20.8%), and SSB (19.7%). In the multivariable logistic analysis, significant predictors of concurrent ANA and subserologies were the labs being ordered from subspecialty care (OR 8.12, 95% CI 5.27-12.50, p-value <0.0001) or from urgent/inpatient care (OR 3.86, 95% CI 1.78-8.38, p-value 0.001). A significant predictor of decreased odds was male gender (OR 0.32, 95% CI 0.21-0.49, p-value <0.0001). Five individuals (2.2% of the negative ANA with subserologies ordered) had a negative ANA but positive subserologies. CONCLUSION: Of 3221 ANA, 6.6% were performed concurrently with subserologies, and subspecialists were more likely to order concurrent tests. A negative ANA predicted negative subserologies with rare exceptions, which validates the ACR's recommendations.
