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2.
Medicine (Baltimore) ; 98(44): e17744, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689826

RESUMO

Congenital syphilis (CS) can cause serious impact on the fetus. However, congenital syphilis presenting as sepsis is a critical condition but hardly identified by the clinic for the first time. In this study, we aimed to identify the benefit of earlier and accurate diagnosis for the infants who suffer congenital syphilis presenting as sepsis.A retrospective study was performed with patients diagnosed of congenital syphilis presenting as sepsis who were the inpatients in the West China Second Hospital between 2011 and 2018. The control group was collected in the neonatal sepsis patients whose blood culture are positive.Fifty-eight patients were included in the study. In the congenital syphilis group, one patient died and 12 (41.3%) patients get worse to MODS (multiple organ dysfunction syndrome). Symptoms, signs, and lab examinations are found to be significantly different (P < .05) between two groups as below, including rash, palmoplantar desquamation, abdominal distension, splenomegaly, hepatomegaly, etc. And, at the aspect of Hb, PLT, WBC, CRP, ALT, AST, these differences occurred in the different groups. It is obvious that the prognosis of children with syphilis is worse. According to a comparison between the different outcomes in the CS, the worse outcome subgroup of patients is significantly younger and have more severely impaired liver function.Because of the high mortality of these infants, pediatricians should improve awareness of CS. Syphilis screening is recommended for pregnant women.


Assuntos
Sepse Neonatal/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Sepse/diagnóstico , Sífilis Congênita/diagnóstico , Sífilis/diagnóstico , Estudos de Casos e Controles , China , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Insuficiência de Múltiplos Órgãos/diagnóstico , Insuficiência de Múltiplos Órgãos/microbiologia , Insuficiência de Múltiplos Órgãos/mortalidade , Sepse Neonatal/microbiologia , Sepse Neonatal/mortalidade , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/mortalidade , Estudos Retrospectivos , Sepse/microbiologia , Sepse/mortalidade , Sífilis/microbiologia , Sífilis/mortalidade , Sorodiagnóstico da Sífilis , Sífilis Congênita/mortalidade
5.
Rev Med Suisse ; 15(666): 1790-1794, 2019 Oct 09.
Artigo em Francês | MEDLINE | ID: mdl-31599519

RESUMO

Actinomycosis is a chronic bacterial infection, caused by the genus Actinomyces, commensal of the digestive and genital tract. The most common presentation of the disease affects the cervicofacial region, but other anatomical sites in the abdomen, thorax and central nervous system may be involved. Differential diagnosis includes neoplasia. Prolonged culture of deep samples in an anaerobic environment is the gold standard of the diagnosis. The treatment of choice is intravenous penicillin G followed by oral amoxicillin for a total duration of 6 to 12 months. However, depending on the location and response to antibiotics, shorter therapy may be considered.


Assuntos
Actinomicose/diagnóstico , Actinomicose/tratamento farmacológico , Actinomyces/patogenicidade , Actinomicose/microbiologia , Actinomicose/patologia , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Humanos , Neoplasias/diagnóstico , Especificidade de Órgãos
7.
Rinsho Ketsueki ; 60(9): 1166-1175, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31597840

RESUMO

The classical myeloproliferative neoplasms (MPN), polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF), are characterized by clonal myeloproliferation without features of myelodysplasia. The diagnostic approach proposed by the World Health Organization (WHO) uses clinical features, peripheral blood counts and smear analysis, bone marrow (BM) morphology, karyotype and molecular genetic tests to classify MPN subtypes. The detection of characteristic driver mutations like JAK2V617F, JAK2 exon 12, MPL, and calrecticulin (CALR) is a major diagnostic feature. JAK2 mutations are detected in more than 90% of patients with PV and are therefore used as highly sensitive clonal marker in this subtype. However, JAK2 mutations may also occur in ET and PMF, while CALR is virtually not seen in PV. Therefore, BM remains the central diagnostic platform and is essential for distinguishing ET from pre-fibrotic PMF and diagnosing cases which do not express JAK2, MPL or CALR ('wild-type' or 'triple-negative' MPN). The standardization of relevant BM features is mandatory to recognize characteristic and easy to assess patterns that enable an accurate discrimination between the MPN subtypes. Key parameters include cellularity, erythropoiesis and neutrophil granulopoiesis in context with specific features of megakaryocytes as well as the BM fiber content, especially in early stage MPN that present with thrombocytosis and clinically mimic essential thrombocythemia.


Assuntos
Transtornos Mieloproliferativos/diagnóstico , Medula Óssea/patologia , Calreticulina/genética , Diagnóstico Diferencial , Eritropoese , Humanos , Janus Quinase 2/genética , Megacariócitos/citologia , Mutação , Neutrófilos/citologia , Policitemia Vera , Trombocitemia Essencial , Organização Mundial da Saúde
8.
Rev Prat ; 69(6): 649-651, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626427

RESUMO

Fibromyalgia is a frequent pain condition. The main symptom is chronic widespread pain during at least 3 months. Many other comorbidities and symptoms are also present. Diagnosis has been revised at multiple occasions during the past 2 decades. The concept is still discussed considering fibromyalgia as a unique diagnosis or a condition including multiple ilnesses. The recent revision in 2016 provides an update of the criteria in order to avoid misclassification (depression). Indeed, applying the previous criteria to regional pain syndromes led to over diagnosis. However, the criteria are not sufficient to diagnose fibromyalgia; complete medical history and physical examination are necessary. There are also diagnostic confounders which should be identified. Morover, some of these confounders may also be associated in some cases with fibromyalgia. Treatments recommended combines multidisciplinary approaches including education, exercises, stress adjustment and if necessary cognitive behavioral therapies. If insufficient, medications such as antidepressents and/or antiepileptics, may be recommended.


Assuntos
Dor Crônica , Transtorno Depressivo , Fibromialgia , Terapia Cognitivo-Comportamental , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Diagnóstico Diferencial , Fibromialgia/diagnóstico , Fibromialgia/terapia , Humanos
9.
Rev Prat ; 69(5): 502-504, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31626451

RESUMO

Osteoarthritis (OA), the most common osteoarticular disease, is a all joint disease. It affects several joint (spine, knee, hip, hands) that are subject to different degrees of mechanical stress. As well, the clinical forms of OA could differ significantly from one subject to another: some could have mono or polyarticular, erosive hand OA or recurrent effusion while we do not know what governs these different clinical presentations. We now consider the pathophysiology of OA according to the patient's risk factors because we know that they involve different pathogenic mechanisms. Thus, four major clinical phenotypes are defined based on risk factors which are age, trauma, obesity/ metabolic syndrome, and family history. Osteoarthritis is therefore a much more complex disease than it has been thought for a long time. The lack of efficient therapeutic may be due in part to the lack of knowledge of these different phenotypes that are always all grouped together in studies. It is therefore necessary to better characterize the different OA to meet the growing needs of care.


Assuntos
Obesidade/complicações , Osteoartrite/classificação , Osteoartrite/diagnóstico , Diagnóstico Diferencial , Articulação da Mão/patologia , Humanos , Articulação do Joelho/patologia , Osteoartrite do Quadril , Osteoartrite do Joelho , Fatores de Risco
10.
Rev Prat ; 69(4): 432-437, 2019 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31626502

RESUMO

Temporo-mandibular disorders -TMD- involve a whole set of anatomical, physiological and clinical disorders that exceed by far the sole temporo-mandibular joint. The main symptom of this condition, most frequent in female patients, is pain. Three syndromes are associated with TMD: a muscular syndrome, not only involving masticatory muscles but also muscles of the neck and pain in seemingly unrelated anatomical regions, which can be misleading; an inflammatory articular syndrome; a mechanical syndrome affecting mouth-opening path. The main treatment of this very common and benign disorder is based on physical therapy. However, physicians should be warned that some patients might exhibit similar symptoms in rare cases of malignant tumor.


Assuntos
Transtornos da Articulação Temporomandibular , Articulação Temporomandibular/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Músculos da Mastigação/patologia , Dor , Articulação Temporomandibular/fisiologia , Transtornos da Articulação Temporomandibular/diagnóstico , Transtornos da Articulação Temporomandibular/terapia
11.
Medicine (Baltimore) ; 98(38): e17315, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568018

RESUMO

Early differential diagnosis of bloodstream infections (BSIs) caused by different sources and species of bacteria in hospitalized patients is crucial for the timely targeted interventions including appropriate use of antibiotics. The aim of this study was to identify 9 biomarkers for the early differentiation of gram-negative-bloodstream infection (GN-BSI), gram-positive (GP)-BSI, and fungal-BSI.A prospective study was conducted for a total of 390 inpatients who underwent blood culture in the Chinese PLA General Hospital from September 2015 to March 2018. Patients with positive culture of a single pathogen were divided into GN-BSI, GP-BSI, and Fungal-BSI groups, and a culture-negative disease control group was also established. The serum levels of macrophage inflammatory protein 1ß (MIP-1ß), tumor necrosis factor α (TNF-α), interleukin (IL)-3, interferon (IFN)-γ, IL-17A, IL-4, IL-12p70, and P-selectin were detected and the NLR was calculated from routine blood test. Receiver-operating characteristic analysis was used to determine the efficacy of various indicators in the differential diagnosis of BSIs. Prediction and validation experiments on clinical patient samples (263 cases) were also performed.The level of IL-3 in the GP-BSI group was significantly higher than those in the other 3 groups. The level of IFN-γ in the fungal-BSI group was significantly higher than those in the other 3 groups. NLR, MIP-1ß, TNF-α, IL-17A, and IL3 exhibited some efficacy when distinguishing between GN-BSI and GP-BSI and NLR had the largest area under curve (AUC) (0.728), followed by MIP-1ß with an AUC of 0.679. IFN-γ and IL-3 exhibited some value in differential diagnosis between GN-BSI and Fungal-BSI. IL-3, MIP-1ß, TNF-α, IFN-γ, NLR, IL-17A, and IL-4 exhibited some value in distinguishing fungal-BSI and GP-BSI, with IL-3 had the largest AUC (0.722), followed by MIP-1ß with an AUC of 0.703.NLR and MIP-1ß may be valuable in differentiating GN-BSI from GP-BSI in hospitalized patients. IFN-γ and IL-3 may be helpful in differential diagnosis GN-BSI and fungal-BSI. IL-3 and MIP-1ß exhibited some diagnostic efficacy in distinguishing fungal-BSI and GP-BSI. Additionally, IL-3 with high serum level may be a marker for GP-BSI and IFN-γ with high serum level may be a valuable marker for the prediction of Fungal-BSI. The utility of these biomarkers to predict BSIs owing to different pathogens in hospitalized patients needs to be assessed in further studies.


Assuntos
Bacteriemia/diagnóstico , Quimiocina CCL4/sangue , Infecção Hospitalar/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Interferon gama/sangue , Interleucina-12/sangue , Interleucina-17/sangue , Interleucina-3/sangue , Interleucina-4/sangue , Micoses/diagnóstico , Proteínas NLR/sangue , Selectina-P/sangue , Fator de Necrose Tumoral alfa/sangue , Bacteriemia/sangue , Bacteriemia/microbiologia , Biomarcadores/sangue , Infecção Hospitalar/sangue , Infecção Hospitalar/microbiologia , Diagnóstico Diferencial , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/sangue , Micoses/microbiologia , Estudos Prospectivos
13.
J Comput Assist Tomogr ; 43(5): 786-792, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31609295

RESUMO

We aim to review the imaging findings of Klippel-Trenaunay syndrome. This disorder characterized clinically by a triad of capillary malformations manifesting as a port-wine stain, venous varicosities typically along the lateral aspect of the lower extremities, and bone and/or soft tissue hypertrophy. Imaging of extremities shows unilateral venous varicosities, persistent embryonic veins, anomalous of the superficial and deep venous system, low-flow venolymphatic malformations, and bony and soft tissue hypertrophy. Other findings include neurospinal as cavernoma, aneurysm, and hemimegalencephaly, pulmonary as pulmonary thromboembolism and pulmonary hypertension and visceral as gastrointestinal and genitourinary vascular anomalies. Imaging may detect associated lesions and differentiate from simulating lesions.


Assuntos
Síndrome de Klippel-Trenaunay-Weber/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Fenótipo
15.
Rev Soc Bras Med Trop ; 52: e20190044, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618305

RESUMO

We present a case of atypical presentation of secondary syphilis with extensive lymph node involvement and pulmonary lesions, initially suspected as lymphoma. The patient presented with weight loss, dry cough, chest pain, palpable lymph nodes in several peripheral chains, and multiple pulmonary nodules and masses on chest imaging. The key features for secondary syphilis diagnosis were a lymph node biopsy suggestive of reactive lymphadenopathy, positive serologic tests for syphilis, and complete recovery after antisyphilitic treatment.


Assuntos
Pneumopatias/diagnóstico , Linfadenopatia/diagnóstico , Linfoma/diagnóstico , Sífilis/diagnóstico , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Pneumopatias/microbiologia , Linfadenopatia/microbiologia , Masculino , Sífilis/complicações , Tomografia Computadorizada por Raios X
16.
Med Clin North Am ; 103(6): 1035-1054, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582003

RESUMO

Neurofibromatosis type 1 (NF1), NF2, and schwannomatosis are related, but distinct, tumor suppressor syndromes characterized by a predilection for tumors in the central and peripheral nervous systems. NF1 is one of the most common autosomal dominant conditions of the nervous system. NF1 has a high degree of variability in clinical presentation, which may include multiple neoplasms as well as cutaneous, vascular, bony, and cognitive features. Some of these manifestations overlap with other genetic conditions. Accurate diagnosis of NF1 is important for individualizing clinical care and genetic counseling. This article summarizes the clinical features, diagnostic work-up, and management of NF1.


Assuntos
Testes Genéticos/métodos , Neurilemoma/diagnóstico , Neurofibromatoses/diagnóstico , Neurofibromatose 1 , Neoplasias Cutâneas/diagnóstico , Diagnóstico Diferencial , Gerenciamento Clínico , Humanos , Neurofibromatose 1/diagnóstico , Neurofibromatose 1/terapia
17.
Medicine (Baltimore) ; 98(42): e16987, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626079

RESUMO

RATIONALE: Oral bleeding is usually diagnosed after by referral to other department for the differential diagnosis of hematemesis or hemoptysis. If a patient presents with blood in the oral cavity with no obvious source, generally upper airway, pulmonary, or gastroesophageal lesions are considered likely bleeding foci. The tongue base is an unusual site for laryngopharyngeal varices and only a few cases have been reported. PATIENT CONCERNS: Although varix at the tongue base in patients with liver cirrhosis has been rarely described, physicians must consider variceal bleeding from the tongue base when presented with oral bleeding. In such cases, bleeding foci can be identified and controlled by laryngoscopy. We describe the case of a 42-year-old woman complaining of small amount of hemoptysis with variceal bleeding at the tongue base controlled by laryngoscopic excision and cauterization. DIAGNOSIS: A diagnosis of tongue base varix was made based on medical history, clinical manifestations, laryngoscopic findings and pathologic features for the patient. INTERVENTIONS: The successful laryngoscopic procedures were performed. OUTCOMES: The patient has shown no recurrent oral bleeding during follow-up. LESSONS: Variceal bleeding in the tongue base is likely to cause serious massive hemorrhage. We need to consider this possibility when presented with a patient with intraoral bleeding but no evidence of hemoptysis or hematemesis.


Assuntos
Hemorragia/etiologia , Língua/irrigação sanguínea , Varizes/complicações , Adulto , Cauterização , Diagnóstico Diferencial , Feminino , Humanos , Laringoscopia/métodos , Lasers de Gás/uso terapêutico , Língua/cirurgia , Resultado do Tratamento , Varizes/patologia
18.
Medicine (Baltimore) ; 98(42): e17416, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626097

RESUMO

This study aims to evaluate the clinical value of haptoglobin (Hp) and sCD163 testing for the differential diagnosis of pleural effusion, and investigate the correlation of Hp and sCD163 with the inflammatory response of the body.Pleural effusion samples were collected from 78 patients (38 tuberculous pleural effusions [TPE] and 40 malignant pleural effusions [MPE]). The concentrations of Hp and sCD163 in the pleural effusion were measured by enzyme-linked immunosorbent assay (ELISA).The concentrations of Hp and sCD163 were significantly higher in the TPE group than in the MPE group (P < .05). The sensitivity and specificity of the Hp test for the differential diagnosis of TPE and MPE was 82.4% and 86.1%, respectively (P < .01), while the cut off value was 779.05 ug/mL. Furthermore, the sensitivity and specificity of the sCD163 test for the differential diagnosis of TPE and MPE was 76.3% and 85.0%, respectively (P < .01), while the cut off value was 16,401.11 ng/mL. Moreover, the sensitivity and specificity of the combination of Hp and sCD163 tests for diagnosing TPE was 90.0% and 87.5%, respectively. Hp and IL-1ß, TNF-α, CRP and ESR were positively correlated in both the TPE group and MPE group (P < .05). Hp and sCD163 were positively correlated in the TPE group (r = 0.3735, P = .0209), but not in the MPE group (r = 0.22, P = .1684). However, there was no correlation between sCD163 and TNF-α, CRP and ESR in either the TPE group, or the MPE group (P > .05). Furthermore, sCD163 and IL-1ß were weakly correlated in the TPE group (r = 0.49, P = .0018), but these had no correlation in the MPE group (r = 0.068, P = .6767).Hp and sCD163 can be used as biological markers for the differential diagnosis of pleural effusion in clinic, and the level of Hp in pleural effusion may reflect the intensity of inflammation in the body to some extent.


Assuntos
Antígenos CD/sangue , Antígenos de Diferenciação Mielomonocítica/sangue , Haptoglobinas/análise , Derrame Pleural Maligno/diagnóstico , Receptores de Superfície Celular/sangue , Tuberculose/diagnóstico , Idoso , Biomarcadores/sangue , Sedimentação Sanguínea , Proteína C-Reativa/análise , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Interleucina-1beta/sangue , Masculino , Pessoa de Meia-Idade , Derrame Pleural Maligno/sangue , Curva ROC , Sensibilidade e Especificidade , Fator de Necrose Tumoral alfa/sangue
19.
Medicine (Baltimore) ; 98(42): e17584, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626128

RESUMO

RATIONALE: High-stage endometrial carcinoma is an aggressive tumor with a high propensity for distant spread. However, metastases to the pericardium are rare in gynecological cancer, and are usually fatal. PATIENT CONCERNS: A 69-year-old woman was diagnosed with endometrial carcinoma with pericardium metastasis. The symptoms at presentation were panic and shortness of breath. DIAGNOSES: The cytologic examination of pericardial fluid obtained by pericardiocentesis confirmed metastasis. INTERVENTIONS: In addition to cisplatin instilled into the pericardial space, for systemic chemotherapy, we chose that gemcitabine and lobaplatin regimen be preferred. OUTCOMES: The patient has been participating in telephone follow-up for 8 months and has generally remained in a good condition. LESSONS: Endometrial carcinoma can have pericardial metastases. When this happens, we recommend ultrasound-guided pericardial puncture and the pericardial injection of cisplatin, in combination with systemic chemotherapy that consists of gemcitabine and lobaplatin.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias do Endométrio/secundário , Neoplasias Cardíacas/complicações , Derrame Pericárdico/etiologia , Pericardiocentese/métodos , Idoso , Terapia Combinada , Diagnóstico Diferencial , Ecocardiografia , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/terapia , Feminino , Neoplasias Cardíacas/secundário , Neoplasias Cardíacas/terapia , Humanos , Imagem por Ressonância Magnética , Derrame Pericárdico/diagnóstico , Derrame Pericárdico/terapia , Pericárdio , Tomografia Computadorizada por Raios X
20.
Medicine (Baltimore) ; 98(42): e17619, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626141

RESUMO

RATIONALE: Liposarcomas are locally invasive mesenchymal soft tissue tumors; most deep liposarcomas are large. Liposarcomas have heterogeneous histomorphology, molecular and genetic characteristics, and clinical prognosis, making the diagnosis and treatment of giant liposarcomas difficult for bone tumor surgeons. PATIENT CONCERNS: A 70-year-old man presented with a mass in the posterior part of his left lower extremity that was first noticed 3 years prior. The mass was initially fist sized but continued to grow and had been affecting lower limb mobility on presentation. DIAGNOSES: Computed tomography and magnetic resonance imaging revealed a large space-occupying lesion in the left thigh muscles, which was identified as a low-grade malignant tumor. Postoperative pathology results confirmed the diagnosis of atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDLPS). INTERVENTIONS: The patient underwent open surgery to completely remove the tumor tissue and relieve pain. OUTCOMES: At the 10-month follow-up appointment, the patient had recovered well, function of the lower extremities had returned to normal, and no signs of recurrence or metastasis were noted. LESSONS: Although ALT/WDLPS is a locally invasive tumor with good prognosis, delayed treatment is associated with increased tumor size, which can affect lower limb mobility. Therefore, we believe that extensive surgical resection of tumor tissue is a suitable treatment for all ALT/WDLPS cases in order to avoid possible local recurrence. In addition, for ALT/WDLPS tumors that are difficult to extensively excise, long-term follow-ups are necessary due to the possibility of recurrence.


Assuntos
Lipossarcoma/diagnóstico , Imagem por Ressonância Magnética/métodos , Neoplasias de Tecidos Moles/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Idoso , Biópsia , Diagnóstico Diferencial , Humanos , Extremidade Inferior , Masculino
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