Protracted Course Research Articles

Ефективність застосування пілатесу як засобу фізичної терапії у жінок з дегенеративно-дистрофічними ураженнями поперекового відділу хребта

Degenerative-dystrophic lesions of the lumbar spine are characterized by a systemic multifactorial course and significantly affect the quality of life. Spinal pain due to degenerative-dystrophic diseases very often affects middle-aged people, in particular women, leading to temporary or permanent disability. Degenerative-dystrophic diseases of the spine are accompanied by neurological manifestations, pain syndromes, prone to a protracted course and have repeated relapses. The purpose of the study was to determine the features of physical therapy to improve the functional state of the spine in middle-aged women with degenerative-dystrophic lesions of the lumbar spine. Materials and methods. The following research methods were used in the study: theoretical analysis of scientific and methodological literature, empirical (determination of the functional state of the muscles of the trunk), pedagogical experiment, methods of mathematical statistics. The study involved 28 women. The main group and the comparison group of 14 people each were formed by the method of random sampling, the average age of the subjects was 40.44 ± 1.25 and 41.60 ± 1.14 years old, respectively. The main group was studied according to the developed program of physical therapy with the use of Pilates, the comparison group – according to the program of therapeutic gymnastics (general developmental orientation) of the communal non-profit enterprise "Zaporizhzhya Regional Clinical Hospital". The study of the functional state of the muscles of the trunk was assessed according to the following tests: the time of holding the lateral support; keeping the support lying on the forearms; static body retention; holding the torso at an angle of 60˚; flexion and extension of the spine. Results and discussion. According to the results of the final rehabilitation examination, it was found that in the comparison group it was not possible to record a possible improvement in the functional state of the muscles of the trunk and the amplitude of the spine. At the same time in the main group such changes occurred in all the studied parameters. In particular, the index of lateral support retention in the main group significantly increased by 8.00 s (p <0.05), retention of the support lying on the forearms – by 10.00 s (p <0.05), static trunk retention - by 9.5 s (p <0.05), holding the trunk at an angle of 60˚ - by 10.00 s (p <0.05), flexion of the spine – by 3.00 cm (p <0.05), extension of the spine – by 5.00 cm (p <0.05). Conclusion. The results of the study indicate that Pilates is an effective means of improving the functional state of the muscles of the trunk and the amplitude of the spine, which was confirmed by significantly better indicators of functional tests in the main group compared with the women in the comparison group

Mouse Model of Critical Persistent Inflammation, Immunosuppression, and Catabolism Syndrome.

Persistent inflammation, immunosuppression, and catabolism syndrome (PIICS) is a growing challenge in intensive care units (ICUs). PIICS causes a severe illness with high mortality. Currently, treatment is expensive, and the outcomes are dismal. Herein, we established a PIICS model to study the disease pathophysiology and its potential treatment. Using a modified sublethal cecal ligation and puncture (CLP) to induce sepsis (day 1) and the injection of lipopolysaccharide (LPS) to induce an aggravated inflammation response (day 11), CLP + LPS mice recapitulating PIICS features were successfully generated (day 14). Adult male mice were divided into CLP + LPS, CLP + daily chronic stress (DCS), CLP, DCS, LPS, and sham control groups. A survival curve was generated, and phenotypes were analyzed using markers for catabolism, inflammation, and immunosuppression. The CLP + LPS model showed two mortality peaks (after CLP and after LPS), whereas the CLP + DCS and CLP groups showed one peak. Surviving CLP + LPS mice exhibited significantly increased catabolism and inflammatory cytokine levels and aggravated inflammation, including organ inflammation. CLP + LPS mice exhibited strong immune suppression as evidenced by decreased splenic cluster of differentiation (CD)8+ and interferon-γ+CD8+ T cell counts and a concomitant and significant increase in the myeloid-derived suppressor cell population. This CLP+LPS-induced PIICS model differs from acute sepsis models, showing two mortality peaks and a protracted course of 14 days. Compared to previous PIICS models, ours shows a re-aggravated status and higher catabolism, inflammation, and immunosuppression levels. Our aim was to use the PIICS model to simulate PIICS pathophysiology and course in the ICU, enabling investigation of its mechanism and treatment.

Predicting Failure of Conservative Airway Management in Robin Sequence

PURPOSE: While initial management of upper airway obstruction in Robin sequence is traditionally conservative, early identification of patients who failed in this approach would avoid the deleterious effects of prolonged upper airway obstruction and hospitalization. The purpose of the current study was to evaluate patient factors, clinical data, and polysomnographic (PSG) results in hospitalized infants with Robin sequence who were either discharged after successful conservative airway measures (Group 1) or required surgical airway intervention after a protracted hospital course (Group 2). We hypothesized that differences between these two groups may expedite early operative airway procedures in appropriate patients without an initial prolonged and, ultimately, unsuccessful period of conservative management. METHODS: A retrospective review was conducted among infants diagnosed with RS who underwent primary airway management at a single institution from 1994 to 2020. Patient demographics, nutritional and respiratory status, laboratory values, and PSG results were recorded. Airway management was classified as conservative or surgical, and recorded variables were compared between the groups. Unpaired t-test/Wilcoxon-Mann-Whitney test was used to compare continuous data and Chi square test/Fisher exact test for categorical data. To assess the ability of PSG variables to predict failure of conservative management, we performed receiver operator characteristic (ROC) curve analysis. Accuracy was graded based on the area under the curve (AUC) defined as “poor” (AUC 0.60–0.70), “fair” (AUC 0.70–0.80), “good” (AUC 0.80–0.90), and “excellent” (AUC 0.90–1.00). Optimal cut-points were calculated using the Youden index (J) method. RESULTS: In total, 122 infants with Robin sequence were analyzed. Conservative airway measures were successful in 61 patients (Group 1), while 61 infants failed this approach after a mean period of 23 days and required a surgical airway procedure (Group 2). Lower 5-minute Apgar scores and associated pulmonary, CNS, and reflux disease were seen more frequently in Group 2 patients. A significantly smaller proportion of patients in Group 2 also demonstrated adequate oral intake compared with Group 1 patients (5% versus 28%, P < 0.001). The surgically managed patients required greater respiratory support or intubation, as well as higher levels of maximum CO2 (67.8 versus 51.4 mm Hg, P < 0.001) and maximum HCO3 (32.7 versus 28 mmol/L, P = 0.001). PSG results in Group 2 patients documented a higher percentage of time with O2 saturation < 90% (10.4% versus 1.1%, P = 0.005) and overall higher apnea-hypopnea index (AHI) (59.7 versus 20.6 events/hour, P < 0.001). Good predictors for failure of conservative airway management (AUC range: 0.80–0.85) included AHI, obstructive AHI (OAHI) REM, OAHI non-REM, and maximum ETCO2 (asleep). Cut points most predictive for failure of conservative management by ROC curve analysis included: AHI > 16.9, OAHI REM > 25.9, OAHI non-REM > 23.6, and maximum ETCO2 > 49 mm Hg. CONCLUSIONS: The current study identified patient factors and PSG results in infants with RS that were associated with persistent upper airway obstruction despite weeks of conservative airway management. Our data may expedite earlier definitive treatment of these critical patients that is essential to reducing risk for known complications such as hypertension, metabolic syndrome, and neurocognitive dysfunction.

Current approaches to the treatment of rhinosinusitis

Relevance: despite the available methods and medicines, rhinosinusitis occupies a leading place in the structure of diseases of the upper respiratory tract. Rhinosinusitis can be a consequence of respiratory viral infections, can be an independent nosological unit. In recent years, there has been a protracted course of rhinosinusitis with a long recovery period with chronic inflammation in the paranasal sinuses and nasal cavity. Purpose of the study: to analyze the validity and effectiveness of therapeutic approaches to the treatment of chronic rhinosinusitis using the Polydexa with phenylephrinum nasal spray with phenylephrine Materials and мethods: The study included 121 patients — 61 (50.41 %) women and 60 (49.59 %) men aged 25 to 50 years, a history of chronic rhinosinusitis in the stage of clinical exacerbation at the time of the study. All patients underwent: otorhinolaryngological examination, general clinical and radiological (radiography or computed / magnetic resonance imaging of the paranasal sinuses). Cytological examination of the detachable nasal cavity was carried out to study the calculation of the relative number of neutrophilic granulocytes, macrophages, epithelial cells, lymphocytes. Microbiological examination of the detachable nasal cavity and paranasal sinuses included the study of the qualitative and quantitative composition of pathogenic and opportunistic organisms on the surface of the nasal mucosa. Results: in patients with chronic rhinosinusitis in the stage of clinical exacerbation, an increase in the relative content of inflammatory elements was revealed in the nasal secretion against the background of the prevailing content of pathogenic staphylococci and streptococci. The use of topical preparations containing antibacterial components of a broad antimicrobial spectrum of action, dexamethasone, phenylephrine hydrochloride helps to relieve inflammation on the surface of the mucous membranes of the nasal cavity and paranasal sinuses. Conclusions: a method of treating chronic rhinosinusitis in the stage of clinical exacerbation using a combined preparation for topical application containing neomycin sulfate, polymyxin B sulfate, dexamethasone sodium metasulfobenzoate, phenylephrine hydrochloride has a pronounced anti-inflammatory, decongestant, antibacterial effect

477 Surgical Solutions and Problems in An Adult Patient with VACTERL Association

Abstract Background We report an adult patient with features of VACTERL - oesophageal and anal atresia, with cardiac malformation. In infancy he underwent colonic interposition for oesophageal atresia using the transverse colon as a conduit. As a teenager he underwent formation of a Koch continent ileostomy after previous stoma formation for anal atresia. Eventual failure of the Koch pouch nipple valve necessitated a laparotomy for attempted refashioning. Unfortunately, this operation was beset by life-threatening complications and a protracted post-operative course. He presented to our hospital with a laparostomy, high output enterocutaneous fistulae (ECF) necessitating home total parenteral nutrition (TPN), severe cachexia and deconditioning. Method Conservative therapy was utilised to improve the nutritional and physiological status of the patient. Simultaneously, attempts were made to define the anatomy of his abdomen in relation to previous surgery. However, operation notes for the original procedures (oesophageal reconstruction and Koch pouch formation) were lost due to closure of the hospital which he attended at the time. A laparotomy was subsequently performed to manage the ECFs. Most of the small intestine was unsalvageable due to multiple fistulae and adhesions, leaving 35cm of small bowel terminating in an end ileostomy. A cholecystectomy was performed to mitigate gallstone formation. Conclusions Efficient communication is imperative in the management of complex patients. The loss of original operation notes made interpretation of subsequent imaging and planning of surgery troublesome. In contrast, efficient communication between teams involved in his peri-operative care, particularly the respiratory and intensive care teams facilitated a smooth post-operative course and successful discharge from hospital.

1451 Early Experiences with Covid-19 In Surgical Patients at The Start of The Global Pandemic

IntroductionCovid-19 is a global threat which had emerged rapidly over the course of last year and is particularly deleterious to those with multiple co-morbidities. While limited data is available on the outcomes of emergency surgical patients infected with SARS-CoV-2, initial reports suggest prolonged post-operative course. Early Covid-19 diagnosis and understanding its impact on outcomes are essential for appropriate management of emergency surgical patients. We aim to report a tertiary hospital’s experiences with the first UK patients infected with Covid-19 at the time of surgery.MethodA limited consecutive, case series (n = 4) was completed in March-April 2020 in a single tertiary centre with a review of case notes, image, and laboratory results.ResultsAll patients presented with acute abdominal pathology (appendicitis, incarcerated umbilical hernia and small bowel obstruction). One patient had a laparoscopy whilst the rest underwent open procedures. All patients suffered from multiple co-morbidities and were on average 71 years-old (57-87). Initial SARS-CoV-2 PCR was negative in 3 patients. However, their clinical features, imaging findings and haematological profiles (raised inflammatory markers with lymphopenia) were in keeping with a diagnosis of Covid-19. All patients had a protracted hospital course with an average hospital stay of 22 days (15-30). 3 patients required unplanned ITU (ITU stay: 4-30 days). The length of ITU stay did not correlate with the procedure complexity.ConclusionsThese initial cases suggest that Covid-19 complicates post-operative recovery. Multimodal approach including PCR testing, imaging and haematological profiles is essential to identify patients at risk of post-operative deterioration and thus plan care accordingly.

Granulomatous Facial Dermatoses.

Noninfectious facial papular granulomas can be the presentation of several conditions, including granulomatous periorificial dermatitis, granulomatous rosacea, lupus miliaris disseminatus faciei, and papular sarcoidosis. Although these entities are treated distinctly from one another, they share several clinical and histological characteristics. We present 2 cases of facial papular granuloma: one patient presented with granulomatous rosacea, and the other had a presentation consistent with sarcoidosis but also demonstrated features of granulomatous periorificial dermatitis and had a protracted course of treatment. Such cases exemplify heterogeneity in the evaluation and management of this cutaneous lesion and highlight the necessity of appreciating its various potential causes.

Hypofractionated radiation therapy as palliative management for symptomatic and local control of advanced thoracic malignancies.

Radiation therapy plays an important role for symptom palliation for intrathoracic malignancies ineligible for curative-intent therapy. Limited data exists regarding the role of stereotactic body radiation therapy (SBRT) versus conformal radiation in intrathoracic tumors for palliation. We report the efficacy of hypofractionated RT (or palliative SBRT) in the symptom management and durable control of lung and non-lung intrathoracic tumors. We performed a retrospective review of ninety-two thoracic lesions across 76 patients who completed palliative SBRT with doses ranging 25-50 Gy in 5-10 fractions between 2009 and 2019. Symptoms (cough, chest pain, hemoptysis, shortness of breath) were assessed at consult and 1-6 months follow-up. Local control was evaluated using follow-up CT imaging via RECIST criteria. Descriptive statistics were used to evaluate symptom palliation and Kaplan-Meier method to analyze local control. Of primary lung (Cohort P) lesions, 40% showed stable symptoms, 30% never developed symptoms, and 19% showed symptom relief. CT imaging 1-6 months post-SBRT showed 91% with partial response (PR) or stable disease (SD) in Cohort P and 87% with PR or SD in metastatic (Cohort M) lesions. In patients with initial PR/SD, local control until death was achieved in 71% of Cohort P and 84% of Cohort M. Of our symptomatic patients (Cohort S), 98% showed no symptom progression post-radiotherapy. All patients with hemoptysis at presentation achieved hemostasis post-radiotherapy. Palliative SBRT has the advantage of higher biologic dose without protracted course for patients with limited prognosis. Patients showed significant symptom palliation and long-term local control. Palliative SBRT represents a reasonable treatment modality for incurable thoracic malignancies.

INFECTED SIMULTANEOUS MEDIASTINAL BRONCHOGENIC CYST AND ESOPHAGEAL DUPLICATION CYST MASQUERADING AS A LUNG ABSCESS

TOPIC: Genetic and Developmental Disorders TYPE: Fellow Case Reports INTRODUCTION: Bronchogenic and esophageal duplication cysts are rare but significant developmental anomalies. We present a case with both types of cyst in a single mass mimicking a lung abscess with a protracted treatment course. CASE PRESENTATION: A healthy 26-year-old female was admitted with onset of left sided pleuritic chest pain and fever over 24 hours. Her exam was remarkable for fever and tachycardia; she had elevated markers of infection. Computed tomography (CT) of chest revealed a well-demarcated cystic mass in the left hemithorax with an air-fluid level. She had no prior chest imaging and denied aspiration events or substance use. She was thought to have an intraparenchymal lung abscess, and underwent CT guided aspiration with the drainage of frank purulent material. Because of suspected intraparenchymal location no drain was placed. Fluid cultures and cytology were negative but her sputum grew mucoid pseudomonas aeruginosa, which was an atypical pathogen in this patient. She was treated with four weeks of intravenous cefepime, and two weeks of levofloxacin and metronidazole, with serial imaging. Pleuritic chest pain persisted despite regression of the lesion over a 10-month period (Figures 1-3); after which she underwent resection through a left video-assisted thoracic surgical approach. Intraoperatively, a large densely adherent inflammatory lesion was connected to the esophagus without intraluminal connection. Thick purulent fluid from the cyst was sent for culture and cytology, which were again negative. Pathology of the cystic mass was consistent with an esophageal duplication cyst (EC) (Figure 4B) with an additional noncommunicating bronchogenic cyst (BC) (Figure 4A). At 6months follow-up visit, she was doing well and free of symptoms. DISCUSSION: To our knowledge this is the first case report of de-novo infected dual BC/EC in an adult. Our case highlights the need for consideration of congenital cysts while working up lung abscesses. The diagnosis may be difficult without surgical resection, as characteristic imaging findings are missing in up to half of cases. 1There is likely a role for aspiration of the cyst for both diagnostic and therapeutic purposes, however efficacy and safety data are limited.2 The optimal timing of cyst resection is also not clear, especially in asymptomatic cysts. There is a minimal evidence to support universal surgical resection, though infected and symptomatic cysts will continue to need surgical intervention. 2,3 CONCLUSIONS: Infected congenital cysts can present a diagnostic and therapeutic challenge. Atypical presentations, and lack of improvement with appropriate therapy, are important clues to the diagnosis. REFERENCE #1: St-Georges R, Deslauriers J, Duranceau A, Vaillancourt R, Deschamps C, Beauchamp G, Pagé A, Brisson J. Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult. Ann Thorac Surg 1991; 52:6–13. REFERENCE #2: Kirmani B, Kirmani B, Sogliani F. Should asymptomatic bronchogenic cysts in adults be treated conservatively or with surgery? Interact Cardiovasc Thorac Surg. 2010 Nov; 11(5): 649-59. REFERENCE #3: Fievet L, Gossot D, de Lesquen H, Calabre C, Merrot T, Thomas P, Becmeur F, Grigoroiu M. Resection of bronchogenic cysts in symptomatic versus asymptomatic patients: an outcome analysis, The Annals of Thoracic Surgery (2020) DISCLOSURES: no disclosure on file for Gary Hochhheiser; No relevant relationships by Obieze Nwanna Nzewunwa, source=Web Response No relevant relationships by Edmund Sears, source=Web Response No relevant relationships by Hilamber Subba, source=Web Response

Мікроаспіраційний синдром у практиці педіатра: сучасні особливості і роль у формуванні бронхообструктивного синдрому

У статті наведені дані щодо дослідження поширеності синдрому мікроаспірації серед дітей раннього віку, які перебували в міському дитячому пульмонологічному відділенні з приводу затяжного перебігу обструктивного бронхіту. Була вивчена структура причин мікроаспірації у дітей раннього віку (2010–2015 рр.). Виділено найбільш значущі причини виникнення мікроаспіраційного синдрому залежно від віку дітей. Для більш ефективного збору анамнезу використовували модифікований опитувальник для батьків. У групі ризику за наявністю мікроаспіраційного синдрому в першу чергу знаходяться діти з перинатальним ураженням центральної нервової системи, народжені раніше терміну, з морфологічними і фізіологічними дефектами носоглотки, з м’язовою дистонією. Проявом мікроаспірації можуть бути часті відрижки, блювота під час кашлю, витікання їжі через ніс, зв’язок нападів кашлю з годуванням, посилення або поява кашлю в положенні лежачи, напади нічного кашлю або задухи, тривале збереження покашлювання після нападу. Педіатрам рекомендується уважно спостерігати за дітьми під час кожного годування, бо дисфагія може бути мінливою. Мікроаспіраційний синдром є складним в діагностиці і вимагає комплексного підходу, найчастіше діагностичні маніпуляції носять інвазивний характер. Своєчасна діагностика і лікування мікроаспіраційного синдрому дозволять знизити рівень респіраторної захворюваності у дітей раннього віку та зменшити тривалість перебігу обструктивних бронхітів.

КЛИНИЧЕСКИЕ СЛУЧАИ АНТИФОСФОЛИПИДНОГО СИНДРОМА В ПРАКТИКЕ ВРАЧА-ГЕМАТОЛОГА

In this article, 2 clinical cases of patients with hemostatic problems are considered. 1 case during pregnancy, with confirmed APS and received therapy. The pathology of the hemostasis system of congenital or acquired genesis against the background of pregnancy can lead to an unfavorable outcome in the form of non-developing pregnancy and miscarriage, and maternal mortality. 2 case with autoimmune nature of APS diagnosed at late stages. It is concluded that excessive examination for non-informative indicators can lead to an incorrect interpretation of blood parameters and, as a consequence, to polypharmacy and a protracted course of the disease with the development of life-threatening complications.

Особенности микробного пейзажа верхних дыхательных путей у детей с микроаспирационным синдромом на фоне поражения центральной нервной системы

Актуальность. Бронхолегочная патология занимает ведущее место в структуре заболеваемости детей всех возрастных групп. Одним из факторов, способствующих затяжному течению бронхитов или рецидивирующему бронхообструктивному синдрому, является микроаспирация. Высокий риск развития как острой, так и хронической микроаспирации имеют дети с неврологическими расстройствами. Цель исследования: изучение особенностей течения респираторной патологии и микробного пейзажа верхних дыхательных путей у детей с микроаспирационным синдромом на фоне поражения центральной нервной системы (ЦНС). Материалы и методы. Проведено комплексное обследование 30 детей в возрасте от 1 мес. до 12 лет (средний возраст пациентов — 4,60 ± 0,03 года) с патологией ЦНС. Основную группу составили 18 детей с перинатальным поражением ЦНС, имеющие в анамнезе затяжные и рецидивирующие бронхиты, группу сравнения — 12 респираторно-асимптомных детей с перинатальным поражением ЦНС. Исследование включало детальный сбор анамнеза, объективное обследование детей и лабораторно-инструментальные методы. У всех больных изучали микробный спектр верхних дыхательных путей, полученный путем глубокого мазка из ротоглотки. Для статистической обработки полученных результатов использовалась программа Statistica 13.0. Результаты. Установлено, что микроаспирационный синдром встречается преимущественно у детей с тяжелой сочетанной патологией ЦНС. Респираторная патология у данной категории пациентов характеризуется рецидивирующими бронхитами (средняя частота за год — 5,9 ± 0,4), их ранней манифестацией (средний возраст начала бронхитов — 4,4 ± 0,5 мес.) и затяжным течением (средняя продолжительность бронхитов — 1,5 ± 0,1 мес.). Особенностью микробного пейзажа верхних дыхательных путей у детей с микроаспирационным синдромом на фоне поражения ЦНС является доминирование кишечной условно-патогенной микрофлоры (Klebsiella pneumoniae, Proteus vulgaris и Proteus mirabilis), а также Pseudomonas aeroginosa и дрожжеподобных грибов рода Сandida. Выводы. Полученные результаты имеют важное практическое значение при выборе стартового антибактериального препарата для лечения затяжных бактериальных бронхитов у детей с микроаспирационным синдромом на фоне поражения ЦНС.

Dysfunctional labor and hemoperitoneum secondary to an incidentally discovered dysgerminoma: a case report

BackgroundOvarian dysgerminoma, a subtype of malignant germ cell tumor (GCT), is a rare ovarian neoplasm that is infrequently found in the gravid patient. When dysgerminomas do occur in pregnancy, the rapidly growing tumors can have a heterogeneous presentation and lead to peripartum complications and morbidity. Due to the rarity of this condition, diagnostic and therapeutic strategies are not well described in the literature.Case presentationA healthy multigravida with an uncomplicated antenatal history presented for elective induction of labor. She had a protracted labor course, persistently abnormal cervical examinations, and eventually developed a worsening Category II tracing that prompted cesarean birth. Intraoperatively, a 26 cm pelvic mass later identified as a Stage IA dysgerminoma was discovered along with a massive hemoperitoneum. The mass was successfully resected, and the patient remains without recurrence 6 months postoperatively.ConclusionAlthough rare and generally indolent, dysgerminomas can grow rapidly and cause mechanical obstruction of labor and other complications in pregnancy. Pelvic masses, including malignant neoplasms, should be included in as part of a broad differential diagnosis when evaluating even routine intrapartum complications such as abnormal labor progression. Additionally, we demonstrate that adnexal masses can be a source of life-threatening intraabdominal hemorrhage.

Recurrent acute pancreatitis in a Wilson disease patient: an unusual association

BackgroundWilson’s disease is a multisystem disorder with predominant clinical symptoms depending on the site of copper deposition in the body. Hepatic presentation is usually seen in the younger age group. And pancreatitis is rarely associated with Wilson’s disease. To the best of our knowledge, recurrent acute pancreatitis as a presenting manifestation in a WD patient has not been mentioned before in the literature.Case presentationWe report a 17-year-old boy who presented with recurrent acute pancreatitis and subsequently developed deranged liver enzymes and ascites. Work up for the cause of recurrent acute pancreatitis was normal. Low ceruloplasmin (0.07 mg/dL), high 24-h urinary copper excretion (576 μg/day), and dry copper content in the liver (270 μg/g) clinched the diagnosis of Wilson’s disease. The patient was started on a low-copper diet and D-penicillamine therapy resulting in an improvement in symptoms and no further recurrence of pancreatitis.ConclusionThe possibility of Wilson’s disease should be considered in young patients with recurrent acute pancreatitis, who have a protracted and obscure disease course.

Honorrhoid paraurethritis in women

According to Johansen (Venereology and Dermatology, 1924, No. 2), one of the main reasons for the protracted course of gonorrhoid urethritis in women is inflammation of the so-called paraurethral ducts blind tubules located near the urethra and lined with stratified squamous or polymorphic epithelium.

Frequent Eczematous Dermatitis in Unrelated Cord Blood Hematopoietic Cell Transplant Recipients Compared With Other Donor Types

We have consistently noticed in our clinical practice eczematous dermatitis (EcD) without other pathologic findings of graft-versus-host disease (GVHD) in recipients of unrelated cord blood transplantation (CBT). We hypothesized that the incidence of EcD was higher in CBT compared with other donor types, and our objective in this study was to compare the frequency, clinical course, and response to therapy of EcD between CBT and non-CBT recipients. We conducted a retrospective study of 720 consecutive adult recipients of allogeneic hematopoietic cell transplants from 2010 to 2016 from any donor type and with follow-up for at least 1 year after transplantation. After using keyword-based automated scanning to identify "eczema," "dermatitis," or "spongiosis" terms in medical records, we retrieved 217 cases for manual record review. We identified 23 EcD cases (12 in CBT recipients and 11 in patients with other types of donors) with a median onset at 8 months after transplantation. The 2-year cumulative incidence of EcD was 20% (95% confidence interval [CI], 11.2% to 31.5%) after CBT and 1.7% (95% CI, .90% to 2.90%) with other types of donors (P < .0001). Fifteen cases had a skin biopsy without distinctive pathologic features of GVHD. The most common EcD-involved sites in CBT recipients were face (75%), neck (50%), and antecubital fossae (50%). Compared with patients with other types of donors, EcD after CBT was more likely to involve three or more sites (10 of 12 vs. 2 of 10; P=.008) and had a more protracted course (lasting >6 months in 6 of 58 vs. 1 of 661; P < .0001). In both groups, EcD responded to topical therapy, and only a few cases required systemic therapy. EcD is a relatively frequent skin condition among recipients of unrelated CBT. Irrespective of donor type, most cases of EcD can be successfully managed with only topical therapy. These findings will help providers recognize EcD, avoid potentially harmful systemic therapy, and better counsel transplant recipients.

A Study on Microbial Profile of Corneal Ulcer Cases in a Tertiary Health Care Centre of Southern Assam

Background-Visual impairment due to corneal ulceration has for long been acknowledged as leading cause of blindness both worldwide and in India only next to Cataract. The aetiology for infective corneal ulcer varies considerably with occupation of patients in different regions of India. Thus, continuing with empirical management without lab diagnosis leads to protracted clinical course. So, understanding the microbial profile of corneal ulcers in agriculture dependent population of Southern Assam helps in improved management of this morbidity. Aims- To 1) Find the prevalence of infected corneal ulcers in untreated patients attending Ophthalmology department of a tertiary care hospital of Southern Assam. 2) Study the pattern of microbial aetiology in the infected corneal ulcer cases. 3) Find the association of infected corneal ulcers with various attributing factors. Method-Corneal scrapings from 86 routine untreated cases of corneal ulceration from Ophthalmology Department were studied prospectively from Dec2017 to Jan2019 and subjected to Gram staining and direct examination with 10%KOH. Culture on SDA and Blood Agar were incubated at 25°C and 37°C respectively and followed up for 3 weeks before declaring sterile. Antimicrobial sensitivity was performed for bacterial isolate and yeast-like species. Slide culture and LPCB tease mount were done for identification of moulds. Result- Out of the 86 cases, 58 were positive in direct microscopy, of which 44 were culture positive. Of the 28 samples negative in direct microscopy, 2 were positive by Culture. Bacterial isolates were found in 5 cases and fungal aetiology in 41 cases. Conclusion- The prevalence of infected corneal ulcer as per standard of Culture positivity is 53.5% (46/86). Mycotic involvement was found in 90% cases. Important fungal isolates identified were Aspergillus species, Penicillium species, Curvularia species, Fusarium species, Sarocladium species. Higher prevalence was significantly associated with harvesting season, agricultural practice and history of trauma while diabetes and steroid intake were not significantly associated with mycotic ulcers. Keywords: Corneal ulcer, Assam, Fungal, Fusarium, Sarocladium, Pseudomonas.

Image-guided, intensity-modulated radiotherapy for the treatment of diffuse-type tenosynovial giant cell tumor of the knee

Rationale:Tenosynovial giant cell tumor (TGCT) is a neoplastic, inflammatory disease with a benign but aggressive course that often presents as localized (TGCT-L) and diffuse (TGCT-D) forms based on the growth pattern and clinical behavior. For TGCT-L, simple excision of the diseased synovial tissue is the preferred treatment option, while for TGCT-D, adequate synovectomy is usually tricky but is essential. However, approximately 44% of TGCT-D cases will relapse after surgery alone. Thus, the optimal treatment strategy in patients with TGCT-D is evolving, and standalone surgical resection can no longer be regarded as the only treatment. The previous studies have shown that postoperative adjuvant radiotherapy can reduce recurrence in TGCT, especially in patients with incomplete synovectomy.Patient concerns:In the first case, a 54-year-old male presented with recurrent pain and swelling of the right knee with a protracted disease course (≥10 years). The other patient is a 64-year-old male who developed swelling, pain, abnormal bending, and limited movement of the left knee without obvious inducement.Diagnoses:Clinical and imaging examinations can provide a definitive diagnosis, and pathology is the gold standard. TGCT-D was confirmed by postoperative pathology. After the operation, the patients underwent an MRI re-examination and showed that the lesions of the knee were not completely resected.Interventions:Arthroscopic synovectomy was performed on the patients, and postoperative pathology was confirmed as TGCT-D. Because of incomplete synovectomy, the 2 cases received image-guided, intensity-modulated radiotherapy (IG-IMRT) after the operation.Outcomes:The follow-up time was 1 year, no evidence of disease progression was found in MRI. No obvious adverse effects associated with radiotherapy were detected during the follow-up period.Lessons:These cases and reviews illustrate the necessity of radiotherapy for TGCT-D and that IG-IMRT is a safe and effective method for treating TGCT-D of the knee.

Клинический опыт ведения язвы роговицы неясной этиологии с затяжным течением и наличием токсико-аллергического компонента

Purpose. The representation of the clinical case of corneal ulcer course with unknown etiology in presence of patient's acute toxic and allergic reaction. The patient was under long-term observation of the local ophthalmologist and didn't show positive response to treatment. Material and methods. Patient examination on the date of his encounter sug-gested bacterial etiology of the process. However, the etiological factor wasn't re-vealed by laboratory tests. The presence of toxic and allergic components in biomi-croscopy of both eyes, long-term prestudy antibacterial therapy, character of corneal ulcer gave rise to prescription of the therapy. Results. The main areas of the therapy are allergy medications, antibacterial and antifungal drugs. The positive response in the disease course allowed us to be-lieve that the treatment was accurately prescribed Conclusion. Protracted course of the corneal ulcer without positive response is the subject to estimate the presence of toxic and allergic components. Considering the duration of the disease the antifungal drugs were prescribed at the beginning of the therapy, in spite of the assumption that bacterial etiology of the process may take place. Keywords: corneal ulcer, toxic and allergic reaction.

A Case of Pulmonary Alveolar Hemorrhage Mimicking Community Acquired Pneumonia

Granulomatosis with polyangiitis is a vasculitis that affects small to medium sized blood vessels in the lungs and kidneys. Alveolar hemorrhage is often initially misdiagnosed as pneumonia and treated incorrectly, leading to higher adverse outcomes in patients with undiagnosed vasculitis. We describe a case of a 68-year-old female who presented to our institution and was initially diagnosed and treated for community acquired pneumonia, however, after a protracted clinical course with no improvement in her respiratory status, she underwent a bronchoscopy that revealed pulmonary alveolar hemorrhage, a manifestation of underlying granulomatosis with polyangiitis.