Id: 62: hemophagocytic lymphohistiocytosis caused by infection by ehrlichia chaffeensis: a case report.

We present a case of HLH triggered by severe infection with Ehrlichia chaffeensis in a patient taking methotrexate for seronegative spondyloarthropathy. A 45-year-old man with a history of ankylosing spondylitis taking methotrexate presented to a community hospital with acute onset of nausea, vomiting and diarrhea. Physical examination revealed a febrile patient with diffuse abdominal tenderness with splenomegaly and diffuse maculopapular rash involving the trunk and all extremities. Labs showed leukopenia and thrombocytopenia. Clinical course was complicated by development of acute renal failure, altered mental status and hypoxic respiratory failure requiring endotracheal intubation and mechanical ventilation. Plasmapheresis was initiated due to concern for thrombotic thrombocytopenic purpura with no response. A bone marrow biopsy was performed which revealed a tri-lineage hematopoiesis with increased number of histiocytes, including hemophagocytic forms. Further lab abnormalities included a hypofibrinogenemia, hyperferritinemia, low complement protein C3 and C4, and hypertriglyceridemia. Patient met diagnostic criteria for HLH and was transferred to our tertiary care hospital for further management. Given concern for tick borne disease, patient was started on doxycycline in addition to previously initiated broad spectrum antibiotics. Serum antibody testing was sent for Lyme disease, Rocky Mountain spotted fever and human Ehrlichiosis. Soluble interleukin-2-receptor alpha wa...
Source: Journal of Investigative Medicine - Category: Research Authors: Tags: Pulmonary/Critical Care Source Type: research

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Conclusion3D-CT angiography is useful for the preoperative assessment of vascular anatomical variations of the IMV and IMA for safe intraoperative navigation and prevention of complications during laparoscopy-assisted left-sided colorectal surgery.
Source: Surgery Today - Category: Surgery Source Type: research
AbstractThe aim of this study was to systematically review the feasibility and safety of non-operative management of small bowel obstruction (SBO) in virgin abdomen. A systematic review was performed through December 2019. The primary outcome was the resolution of non-operative management of SBO in virgin abdomen. Secondary outcomes were the etiology of SBO and findings of exploratory laparotomy. Six studies were included in the analysis. Of the 442 patients, 2 with metastatic cancer received palliative care, and the management in 26 was not reported, so these patients were excluded. A total of 414 patients were ultimately...
Source: Surgery Today - Category: Surgery Source Type: research
Conditions:   Mature B-Cell Leukemia Burkitt Type;   Burkitt Lymphoma (BL);   Unclassifiable Lymphoma Between DCBL and BL Interventions:   Drug: Rituximab;   Drug: Methotrexate;   Drug: Dexamethasone;   Drug: Iphosphamid;   Drug: Vincristine;   Drug: Etoposide;   Drug: Cytarabine;   Drug: Cyclophosphamide;   Drug: Doxorubicin;   Drug: Vindesine;   Drug: Hydrocortisone;   Drug: Prednisone Sponsors:   PETHEMA Foundation;   ...
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Sternotomy is indicated when a goiter cannot be resected via a cervical incision, such as in the case of a substernal goiter extending beyond the aortic arch. In this article, we report a case of a large substernal goiter that was successfully removed using the cervical approach only. This is a case of a 68-year-old woman, diagnosed with goiter 20 years ago, who complained of a neck mass enlargement with associated cough. Pathological examination revealed no malignancy. Computed tomography (CT) scan showed an 11-cm thyroid mass reaching the level of the aortic arch. Preoperatively, we evaluated the substernal extent of the...
Source: Case Reports in Oncology - Category: Cancer & Oncology Source Type: research
Conclusion: The GARSL models using both clinical and radiomic features significantly improved the accuracy to predict early recurrence of HCC after surgical resection, which was significantly better than other well-known machine learning-derived models and currently available clinical models.Liver Cancer
Source: Liver Cancer - Category: Cancer & Oncology Source Type: research
This study was aimed to identify hematological and microbiological profile of culture-proven neonatal sepsis in Indonesian tertiary neonatal intensive care unit (NICU).MATERIALS AND METHODS: Hospital based cross-sectional study was conducted in all inborn neonates that were suspected sepsis neonatal over a period of six months from April to September 2019. Complete blood count, c-reactive protein (CRP) and blood culture were examined before antibiotic administration. Statistical analysis were calculated based on Chi-Square's Test and Mann-Whitney U test and p
Source: Iranian Journal of Microbiology - Category: Microbiology Authors: Source Type: research
This study reports a 43 years-old man diagnosed with piriformis pyomyositis. A literature review was conducted by searching MEDLINE via Pubmed for English language case reports, published from 8th December 2019 to 20th January 2020. Patients' symptoms, laboratory tests, imaging, treatment, and other comorbidities were evaluated. Thirty-two cases diagnosed with piriformis pyomyositis, of which 21 patients developed piriformis abscess (including one new patient added by us) of which 52.4% were female, and the mean age was 26.98 ± 17.5. The most common manifestations were fever, lower back pain, and limited ambulation ...
Source: Iranian Journal of Microbiology - Category: Microbiology Authors: Source Type: research
CONCLUSION: Gastrointestinal ischemia represents a rare manifestation of COVID-19. A high index of suspicion should lead to investigate this complication by CT scan, in the attempt to reduce its high mortality rate. Histology shows atypical feature of ischemia with important endotheliitis, probably linked to thrombotic microangiopathies.PMID:34539144 | PMC:PMC8409161 | DOI:10.3748/wjg.v27.i32.5448
Source: World Journal of Gastroenterology - Category: Gastroenterology Authors: Source Type: research
World J Gastroenterol. 2021 Aug 28;27(32):5306-5321. doi: 10.3748/wjg.v27.i32.5306.ABSTRACTThe high incidence of rectal cancer in both sexes makes it one of the most common tumors, with significant morbidity and mortality rates. To define the best treatment option and optimize patient outcome, several rectal cancer biological variables must be evaluated. Currently, medical imaging plays a crucial role in the characterization of this disease, and it often requires a multimodal approach. Magnetic resonance imaging is the first-choice imaging modality for local staging and restaging and can be used to detect high-risk prognos...
Source: World Journal of Gastroenterology - Category: Gastroenterology Authors: Source Type: research
CONCLUSION: Gastrointestinal ischemia represents a rare manifestation of COVID-19. A high index of suspicion should lead to investigate this complication by CT scan, in the attempt to reduce its high mortality rate. Histology shows atypical feature of ischemia with important endotheliitis, probably linked to thrombotic microangiopathies.PMID:34539144 | PMC:PMC8409161 | DOI:10.3748/wjg.v27.i32.5448
Source: World Journal of Gastroenterology : WJG - Category: Gastroenterology Authors: Source Type: research
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