Post-Streptococcus mitis infection polyserositis.

We report a case of a 42-year-old man who presented with acute epigastric and retrosternal chest pain and exertional dyspnoea, and was subsequently diagnosed with polyserositis secondary to post-Streptococcal mitis infection. A CT scan showed a large pericardial effusion requiring pericardiocentesis, small bilateral pleural effusions and small amount of ascites. Several serological tests were done, which were all found to be normal. Pericardial and pleural fluid aspirates revealed an exudate. Culture of the pleural fluid yielded growth of S.  mitis and this was deemed the cause of the polyserositis, which is rare. The patient made a spontaneous recovery. He was started on colchicine by the cardiologists to help prevent pericardial fluid recurrence and this was continued for 3 months. A dental review confirmed the presence of dental caries, the possible source of infection. On follow-up, the patient remained well with no further relapses.

Everolimus-Induced Systemic Serositis After Simultaneous Liver and Kidney Transplantation: A Case Report.

Although everolimus, a mammalian target of rapamycin inhibitor, has been used as a potent immunosuppressive agent in organ transplantation, data regarding its adverse effect profile compared with that of sirolimus in clinical circumstances are limited. A 50-year-old man who underwent simultaneous liver and kidney transplantation 14 months previously was admitted with large pleural effusion, pericardial effusion, and ascites. Laboratory findings and cultures for possible infectious causes were all negative. Pericardial window surgery with drainage of the pericardial fluid was performed on day 3. Pleural and pericardial biopsy revealed non-specific inflammation without evidence of malignant cells. Everolimus was discontinued and replaced by mycophenolate mofetil on day 4. Significant clinical improvement was observed after discontinuation of everolimus, and follow-up echocardiography and chest radiography showed no recurrence of the pericardial or pleural effusion after discharge.

Accuracy of antenatal ultrasound signs in predicting the risk for bowel atresia in patients with gastroschisis.

OBJECTIVE: Evaluate accuracy of prenatal ultrasound findings in predicting the risk of bowel atresia in patients with gastroschisis. METHODS: A retrospective study was conducted on 18 fetuses with a prenatal diagnostic of gastroschisis treated at University hospital of Saint Etienne France between 2002 and 2012. Ultrasound abnormalities were used to classify them into three groups: no ultrasound abnormality (n=4), oligohydramnios (n=9), intra-abdominal bowel dilatation ≥20.5mm (n=5). Postnatal outcomes were compared between groups. The threshold value of 20.5mm for the prediction of atresia was determined through the receiver operator characteristics curve. RESULTS: In the group with oligohydramnios, intra uterine growth restriction were significantly more frequent (p=0.015) and three newborns had serositis including two with secondary complications after the initial surgery. In the group with major intra-abdominal bowel dilatation, all had a narrow defect <10mm significantly more than other fetuses (p=0.002). Intra-abdominal bowel dilatation reaching 20.5mm started at a mean gestational age significantly lower than that of the other fetuses (23.3 versus 29.7 weeks p=0.02). On the five fetuses presented intra-abdominal bowel dilatation ≥20.5mm, four showed atresia and no other newborn has this complication (p=0.0016). The threshold value of 20.5mm has a sensitivity of 100% and a specificity of 92.9%. The area under the curve was equal to 96.4%. CONCLUSION: Intra-abdominal bowel dilatation ≥20.5mm seems to be associated with the risk of postnatal atresia. MRI could help to clarify a complicated or uncertain ultrasound aspect.

[Polyserositic syndromes and/or sectorial dysventilation with platelet activation induced by immunoallergic etiopathogenesis]. / Sindromi polisierositiche e/o disventilatorie settoriali con attivazione piastrinica da etiopatogenesi immunoallergica.

The author from a study of 5 dysventilatorial syndromes (bronchiolitis-PNX, pneumomediastinal aerial cystis of lung) and 5 polysierositic syndromes pleuritis and peritonitis) evices that all these syndromes show in the anamnesis or in present a viral infection from influenzal virus or rubeola. In addition to that, the Authors shows the presence of a food allergy asserted by RAST and/or Skin Prick Tests or FBST (Food Bronchostimulation test) and the introduction of a food allergen during the viral infection, and a great platelet's activation. The Author, besides, shows the association normal VES and normal neutrophil cells in the dysventilatorial syndrome and high VES, and high neutrophil cells in the polysierositic syndromes; in all cases the negativity of culture exams. Starting from these points she worked out a new etiopathogenetic theory: the viral localization on the Peyer's plates cause the expression on the epithelial surface of the gut's cells of SELF HLA II type recognition. The food allergens' introduction causes a great reaction of II, III, IV, VI type which involves the bronchus, alveolus, and the serous epithelium by PAF activation, in all cases and in the polisierositic syndrome a neutrophil activation as well. The author advices to prize the importance of cortisone therapy and of exclusion of food allergen by diet, besides advices the antibiotic therapy for covering only.

Diverticular perforation masquerading as maxillary sinusitis.

Although diverticular perforation and diverticulitis is usually a straightforward diagnosis, an occasional case can be difficult. In this report, we describe a patient who initially presented with symptoms suggestive of maxillary sinusitis and hip fracture. Findings of subcutaneous craniofacial emphysema eventually led to the diagnosis of a perforated sigmoid diverticulum with abscess.

Abdominal computed tomography scan in acute lupus abdominal serositis.

This report demonstrates the value of abdominal computed tomography in the evaluation and management of a patient with abdominal complaints due to systemic lupus erythematosus.