1/610. Bilateral fat necrosis of the scrotum.The typical patient with fat necrosis of the scrotum is a prepuberal heavy set male subject who has extratesticular scrotal masses, usually bilateral, with mild to moderate pain but no systemic complaints or symptons related to voiding. The masses are firm, tender and do not transmit light. With a firm diagnosis expectant treatment will allow spontaneous resolution of the lesions. If doubt exists appropriate surgical intervention is advocated. Hypothermic injury, such as swimming in frigid water, is the most probable etiologic agent.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/610. Sickle cell-like crisis and bone marrow necrosis associated with parvovirus B19 infection and heterozygosity for haemoglobins S and E.In the literature, heterozygosity for haemoglobins S and E is known as a clinically benign condition. Nevertheless, we present a case of double heterozygosity manifesting as an infarctive sickle cell-like crisis with acute chest syndrome and reversible bone marrow necrosis. Importantly, these complications were associated with serologically documented parvovirus B19 infection. Reviewing the literature, this case emphasizes a specific role of parvovirus B19 as a precipitating cause. Furthermore, it demonstrates how important the consideration of haemoglobin disorders can be even outside of the historically known areas.- - - - - - - - - - ranking = 0.32972103596632keywords = chest (Clic here for more details about this article) |
3/610. Necrotizing sarcoid granulomatosis in a 14-yr-old female.A case of a 14-yr-old female with necrotizing sarcoid granulomatosis (NSG) is presented. She was referred because of chest pain and malaise, and radiography revealed multiple pulmonary nodules. Her history showed seasonal sensitization to aeroallergens and hay fever. Infectious agents or malignancies did not characterize these nodules. However, she was treated with macrolide antibiotics because of suspected infection with chlamydia pneumoniae. Open lung biopsy showed histological findings of NSG, with epithelioid granulomatous inflammation, including giant cells, and vasculitis. No further treatment was performed, and symptoms disappeared within a few weeks. The chest radiograph showed gradual improvement. The aetiology of NSG is poorly understood, and is postulated to represent either sarcoidosis or rare forms of pulmonary vasculitis such as Wegener's granulomatosis or the churg-strauss syndrome. In the case presented, a coincidence of infection with chlamydia pneumoniae suggests an involvement of infectious agents in the pattern of formation of immune complexes in the aetiology of NSG.- - - - - - - - - - ranking = 1.6594420719326keywords = pain, chest (Clic here for more details about this article) |
4/610. Intensive tandem cryofiltration apheresis and hemodialysis to treat a patient with severe calciphylaxis, cryoglobulinemia, and end-stage renal disease.This is the first report on tandem cryofiltration apheresis (CFA) and hemodialysis (HD). A 44 year old white man with Type II mixed cryoglobulinemia, hepatitis c virus (HCV), severe skin lesions, and end-stage renal disease (ESRD) on maintenance hemodialysis was air-transferred for CFA, which is only available at our medical center. The patient failed to respond to high dose steroids, immunosuppression, intravenous immunoglobulin (IVIG), and plasma exchange for the treatment of his cryoglobulinemia, and he failed alpha-interferon therapy for his HCV. On arrival, he was also found to have severe calciphylaxis secondary to ESRD with generalized, painful skin ulceration, necrosis, and penile gangrene. To treat both conditions, intensive, tandem CFA/HD was initiated. He received extensive wound care and surgical debridement. To prevent pressure ulcers and worsening of skin lesions, he was placed on the FluidAir (Kinetic Concepts Inc., San Antonio, TX) controlled air bed. The patient received 18 tandem CFA/HD treatments, and four extra HD treatments in one month. sodium citrate was used as an anticoagulant for the CFA procedure. His plasma cryoglobulin (CG) level dropped from 6,157 to 420 microg/ml, and his calciphylaxis also improved. The CFA effectively removed 93% of CG, without significant removal of IgG, IgM, IgA, albumin, and fibrinogen. No albumin or fresh frozen plasma (FFP) was required as replacement fluid for CFA. No citrate toxicity or evidence of complement activation with the cryofilter was observed. The entire CFA procedure time (3(1/2) hours) was considered. Intensive, tandem CFA/HD was performed in a critically ill patient with no apparent adverse consequences.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
5/610. Polyester fibre prosthetic anterior cruciate ligament implant rupture: necrosis of ingrown connective tissue.AIMS: To describe the histopathological and microanalytical features in seven cases of ruptured Apex(R) polyester (Terylene(R)) fibre anterior cruciate ligament prosthesis. methods AND RESULTS: Transmitted and polarized light microscopy was performed in all cases; one case was investigated by immunohistochemistry, transmission electron microscopy and scanning electron microscopy, with backscatter and X-ray detectors for elemental microanalysis. For comparison we also studied synovial biopsy material and unused polyester fibres. In the excised ligaments there was much ingrowth of fibrous tissue accompanying a florid giant cell reaction to the individual intact polyester fibres throughout the ligaments. phagocytosis of particles of prosthesis-derived material was demonstrated and a striking finding was of necrosis of the ingrown connective tissue in the central portions of the ligaments. Hyalinized areas and 'neoligament growth' were less striking. A consistent finding in the polyester fibres was of small particles containing antimony, used as a catalyst in the manufacturing process. CONCLUSIONS: The pattern of reaction to the prosthetic material and the presence of necrosis differ from previous descriptions in animal and human explants of this and other prosthesis types. The mechanical effect of the necrosis is unlikely to be of significance with this ligament, which is load-bearing ab initio.- - - - - - - - - - ranking = 0.072258735199612keywords = back (Clic here for more details about this article) |
6/610. Necrotizing sialometaplasia.Two cases of necrotizing sialometaplasia are reported together with a review of the literature. This self-limiting benign lesion is easily confused with malignant tumors. The lesions are characterized histologically by an extensive necrosis of the salivary gland tissue together with squamous metaplasia of the ducts. The present report of two females who had intense pain in the initial phase differs from previous reports concerning age and symptoms. The importance of rather extensive biopsy specimens is stressed. Antibiotic treatment appears to be insignificant. A clinical history of allergy and a dominance of eosinophilic granulocytes in the inflammatory exudate in both cases may indicate an allergic etiology.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
7/610. Nontraumatic clostridial myonecrosis.We describe three cases of nontraumatic clostridial myonecrosis seen at the Victorian Institute of forensic medicine. Nontraumatic clostridial myonecrosis is an uncommon and often fatal condition that requires immediate institution of appropriate medical and surgical therapy. It is most commonly caused by clostridium perfringens and clostridium septicum and is associated with gastrointestinal and hematologic malignancies, diabetes mellitus, and peripheral vascular disease. The clinical features include a rapidly evolving acute illness with severe pain, marked tachycardia, and brawny discoloration of the skin with bullae formation and crepitus, followed by hypotension and acute renal failure. Features at autopsy include reddish brown skin discoloration with bullae formation and necrotic skeletal muscle. Radiographs may be of use prior to the postmortem in detecting gas within the soft tissues. Gram stain and microbiologic culture are important in establishing a definitive diagnosis; although the major factors in suggesting the diagnosis are the recognition of the typical clinical history and macroscopic autopsy findings.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
8/610. Laminar cortical necrosis in central nervous system lupus: sequential changes in MR images.A 44-year-old woman with systemic lupus erythematosus developed central nervous system lupus presenting with headache, fever, cloudiness of consciousness, and psychotic symptoms. T1-weighted and proton MR images showed laminar high intensity lesions in the parietal and temporal cortex bilaterally. T2-weighted images of the lesions showed low signal intensity. Treatment with corticosteroids alleviated the clinical symptoms within 7 months. The low T2 and high T1 signal abnormalities disappeared in a year and in 5 years, respectively. The laminar cortical lesions on MR images were suggested to represent cortical necrosis associated with central nervous system lupus.- - - - - - - - - - ranking = 0.19388300348454keywords = headache (Clic here for more details about this article) |
9/610. Massive myocardial necrosis in thrombotic thrombocytopenic purpura: a case report and review of the literature.Thrombotic thrombocytopenic purpura (TTP) is an uncommon syndrome resulting from diffuse occlusion of small arterioles and capillaries by hyaline microthrombi. It is characterized by fever, thrombocytopenic purpura, microangiopathic hemolytic anemia, and neurologic and renal dysfunction. While cardiac pathology in TTP is commonly seen at autopsy, clinical cardiac dysfunction is rare and typically results from conduction system involvement. While 3% to 8% of patients with TTP report chest pain on admission, reports of fatal ventricular pump failure are extremely rare. We now report a case of TTP resulting in death from widespread myocardial necrosis. This patient presented with elevated cardiac enzymes and electrocardiographic disturbances that mimicked viral myocarditis, as well as a profound thrombocytopenia. Such a case may represent the extreme of a distribution of cardiac involvement in TTP or the consequence of an unidentified autoimmune process capable of precipitating severe myocardial TTP.- - - - - - - - - - ranking = 1.3297210359663keywords = pain, chest (Clic here for more details about this article) |
10/610. microscopic polyangiitis diagnosed at hysterectomy.A 78 year old female developed polyneuropathy, weight loss, malaise, and joint pain. Necrotizing vasculitis was diagnosed at hysterectomy, and later renal biopsy demonstrated focal segmental necrotizing glomerulonephritis. The pathological findings together with the presence of pANCA was consistent with a diagnosis of microscopic polyangiitis (MPA). This is the first clinical description of MPA with involvement of the uterus.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
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