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The American Journal of Case Reports May 2017BACKGROUND Acute fibrinous and organizing pneumonia (AFOP) is a newly evolving rare non-infectious lung pathology, characterized by intra-alveolar fibrin balls on...
BACKGROUND Acute fibrinous and organizing pneumonia (AFOP) is a newly evolving rare non-infectious lung pathology, characterized by intra-alveolar fibrin balls on histology. It is often difficult to diagnose and is usually mistaken for other lung pathologies. We present an interesting case of AFOP with unusual radiologic findings and disease course. CASE REPORT A 56-year-old woman presented with a 1-day history of high-grade fever, chills, and profuse sweating. She was febrile to 101.2 degree Fahrenheit on presentation. On physical examination, she had decreased air entry in the left upper lobe of the lung. Laboratory testing showed a white cell count of 27,000 cells per microliter of blood with left shift. A chest radiograph showed a left upper lobe consolidation. Computed tomography (CT) of the chest without intravenous contrast showed advanced centrilobular emphysema and left upper lobe consolidation measuring 6.2×5.9 cm. The patient was started on antibiotics. She clinically improved and was discharged on oral antibiotics. After discharge, a trans-bronchial lung biopsy showed acute inflammatory cell infiltrate with intra-alveolar fibrin balls but no hyaline membrane formation or significant eosinophils. These findings were consistent with acute fibrinous and organizing pneumonia. However, she was subsequently lost to follow-up. CONCLUSIONS Our case adds to the literature a new and unusual finding of upper lobe infiltrates, in contrast to most cases presenting as bilateral lower lobe infiltrates. In our case, symptomatic improvement after antibiotic treatment suggests a possible role of antibiotics in management of this entity.
Topics: Chills; Female; Fever; Fibrin; Humans; Lung; Middle Aged; Pneumonia; Pulmonary Emphysema; Sweating
PubMed: 28502975
DOI: 10.12659/ajcr.903539 -
The Laryngoscope May 2012Bimodal stimulation may offer improved auditory function following cochlear implantation. Modification of technique during cochleostomy may minimize trauma and maximize... (Comparative Study)
Comparative Study
OBJECTIVES/HYPOTHESIS
Bimodal stimulation may offer improved auditory function following cochlear implantation. Modification of technique during cochleostomy may minimize trauma and maximize residual hearing. We hypothesize that CO(2) laser use during cochleostomy is useful and may decrease intracochlear trauma. This study examines the utility of CO(2) laser to perform cochleostomy and compares intracochlear sound and temperature levels during laser and drill usage.
STUDY DESIGN
Experimental (30 cadaveric temporal bones).
METHODS
A CO(2) laser at 3 W (four bones) and 6 W (four bones) and otologic drill (six bones) were utilized to perform a cochleostomy while recording operative time. Subsequently, 16 bones were used to simultaneously record intracochlear sound (in decibels) and temperature (in degrees Fahrenheit) during CO(2) laser (eight bones) and drill cochleostomies (eight bones).
RESULTS
Average cochleostomy time for CO(2) laser was 15.5 minutes (3 W) and 7.75 minutes (6 W); it was 8 minutes for the drill. Average intracochlear sound level was 54.9 dB during laser use and 89.9 dB during drill use (P < .001), whereas maximal levels were 75 to 118 dB during laser use and 95 to 136 dB during drill use (P = .018). Average temperature was 63.4°F during laser use and 61.5°F during drill use (P = .151), whereas maximum temperatures ranged from 66 to 120°F during laser use and 62 to 70°F during drill use (P = .045).
CONCLUSIONS
CO(2) laser can create cochleostomies comparable in operative time and intracochlear temperature to drilling while decreasing intracochlear sound levels. Further investigation is warranted to minimize trauma and maximize auditory function during cochleostomy.
Topics: Cadaver; Cochlea; Cochlear Implantation; Hearing Loss, Sensorineural; Humans; Laser Therapy; Lasers, Gas; Minimally Invasive Surgical Procedures; Pilot Projects; Reproducibility of Results; Temporal Bone
PubMed: 22447373
DOI: 10.1002/lary.23231 -
Advances in Skin & Wound Care Aug 2010Increased local temperature is a classic sign of wound infection, and its quantitative measurement has the potential to assist with assessment and diagnosis of chronic...
OBJECTIVE
Increased local temperature is a classic sign of wound infection, and its quantitative measurement has the potential to assist with assessment and diagnosis of chronic deep wound and surrounding skin infection at the bedside. Evidence supporting such use in chronic wound care is very limited. This clinical pilot study was conducted in an attempt to quantify the relationship between increased periwound skin temperature and wound infection, as well as validate use of a handheld infrared thermometer for the wound care practitioner.
DESIGN, SETTING, AND PARTICIPANTS
Using a cross-sectional design, 2 groups of participants were recruited from a chronic wound clinic: without wounds (n = 20) and with chronic leg ulcers (n = 40). Participant and wound characteristics were documented. All skin temperatures were documented using a handheld infrared thermometer under consistent environmental conditions within the clinic. Data analysis was based on the difference (Delta) in skin temperature (in degrees Fahrenheit) between a target or wound site and an equivalent contralateral control site. Wound infection was identified using the combination of a validated assessment tool and clinical judgment. Supplemental semiquantitative bacterial swabs were collected from all wounds.
OUTCOME MEASURES
Descriptive statistics were analyzed using the chi-squared calculation. A Pearson r calculation of test-retest skin temperature data collected from nonwounded participants initially determined reliability of the infrared thermometer. Correlation of increased periwound skin temperature to wound infection was determined by calculation of a 1-way analysis of variance.
MAIN RESULTS
The infrared thermometer was found to be reliable (r = 0.939, P = .000 at a 95% confidence interval). A statistically significant relationship between increased periwound skin temperature and wound infection was identified (F = 44.238, P = .000 at a 95% confidence interval). Neither patient nor wound characteristics were significantly different between the participants with noninfected or infected wounds.
CONCLUSION
The results of this study demonstrate that incorporating quantitative skin temperature measurement into routine wound assessment provides a timely and reliable method for a wound care practitioner to quantify the heat associated with deep and surrounding skin infection and to monitor ongoing wound status. Study limitations may reduce transferability of these findings to wound types other than chronic leg ulcers. Further research is needed to support and strengthen these results.
Topics: Chronic Disease; Cross-Sectional Studies; Humans; Leg Ulcer; Pilot Projects; Skin Temperature; Thermometers; Wound Healing; Wound Infection
PubMed: 20631603
DOI: 10.1097/01.ASW.0000383197.28192.98 -
The Journal of Family Practice May 2010A 66-year-old woman came into the emergency department with a diffuse rash and a cough. She had a rash on the palms of her hands, which had developed the day before, but...
A 66-year-old woman came into the emergency department with a diffuse rash and a cough. She had a rash on the palms of her hands, which had developed the day before, but had improved a bit. She also had a rash on her feet, legs, and lower abdomen, which had developed that morning. She said that over the previous 2 days she had had a fever, dry cough, and some difficulty breathing. Her past medical history was significant for asthma, diabetes, hypertension, and osteoarthritis. Her medications included atenolol, celecoxib, metformin, pioglitazone, and an albuterol inhaler, as needed. In addition, she was on the ninth day of a 10-day course of nitrofurantoin for acute cystitis. She was allergic to ampicillin and erythromycin. On physical exam, she had a fever of 101.5 degrees Fahrenheit. On lung examination, she had diffuse wheezes and mild bibasilar crackles. Examination of her skin revealed a nonpainful, nonpruritic, erythematous, maculopapular rash located on the palms and legs, as well as on her lower abdomen. Chest radiograph showed mild opacification in the bases of the lungs. What is your diagnosis?
Topics: Aged; Anti-Infective Agents, Urinary; Cough; Cystitis; Dyspnea; Exanthema; Female; Fever; Humans; Leukocyte Count; Lung; Lung Diseases; Nitrofurantoin; Radiography; Urinary Tract Infections
PubMed: 20544049
DOI: No ID Found -
Case Reports in Gastrointestinal... 2017We present an atypical case of newly diagnosed colon cancer and provide insight into the infectious predispositions of bacteremia to the development of colon...
We present an atypical case of newly diagnosed colon cancer and provide insight into the infectious predispositions of bacteremia to the development of colon adenocarcinoma. A 66-year-old female was admitted to the hospital with one-week symptoms of subjective fevers, chills, and lower back pain. Upon initial evaluation, her temperature was 101 degrees Fahrenheit with a white count of 12,000 K/mm. Initial septic workup was positive for bacteremia. The patient was started on Aztreonam. Repeat blood culture 48 hours later was negative for any growth. However, later during hospital stay blood culture was repeated due to SIRS, which was positive again for . CT scan of the chest/abdomen/pelvis with contrast revealed no signs of colitis. Without clear etiology for recurrent bacteremia ultimately colonoscopy was performed which showed an ulcerated mass in the cecum. Biopsy showed moderately differentiated adenocarcinoma. strains B2 and D produce cyclomodulin toxins as part of their virulence, which interferes with the cell cycle regulation, promoting chromosomal instability, and increasing susceptibility to cancer. In patients with recurrent bacteremia with an unknown source, colonoscopy should be done to look for colon cancer.
PubMed: 28695023
DOI: 10.1155/2017/2570524 -
The Journal of Reproductive Medicine Aug 1994Toxic shock-like syndrome due to Streptococcus pyogenes is an unusual occurrence. Previously reported cases have been the result of focal infections with S pyogenes. We... (Review)
Review
Toxic shock-like syndrome due to Streptococcus pyogenes is an unusual occurrence. Previously reported cases have been the result of focal infections with S pyogenes. We present a case in which manipulation of a colonized mucosal surface during laparoscopic tubal ligation was the presumed cause of the sepsis syndrome. Whereas other reports of this syndrome have all noted concurrent infections with S pyogenes, in this instance it was unclear if toxin-mediated disease was initiated by mild endometritis or iatrogenic manipulation of a colonized mucosal surface.
Topics: Adult; Anti-Bacterial Agents; Female; Humans; Laparoscopy; Shock, Septic; Sterilization, Tubal; Streptococcal Infections; Streptococcus pyogenes
PubMed: 7996532
DOI: No ID Found -
Vaccine Nov 2016We describe the establishment of a dynamic database linking mothers to newborns with the goal of studying vaccine safety in both pregnant women and their children and...
BACKGROUND/OBJECTIVE
We describe the establishment of a dynamic database linking mothers to newborns with the goal of studying vaccine safety in both pregnant women and their children and provide results of a study utilizing this database as a proof of concept.
METHODS
All Kaiser Permanente Northern California (KPNC) live births and their mothers were eligible for inclusion in the pregnancy database. We used the medical record number (MRN), a unique identifier, to retrieve information about events that occurred during the pregnancy and at delivery and linked this same MRN to newborns for post-partum follow up. We conducted a retrospective cohort study to evaluate the association between receipt of tetanus, diphtheria and acellular pertussis (Tdap) vaccine during pregnancy and fever 0-3days after the first dose of diphtheria tetanus and acellular pertussis (DTaP) vaccine in the infant. The study included infants who were born at ⩾37weeks gestation from January 1, 2009 - October 1, 2015 and who received their first DTaP vaccine between 6 and 10weeks of age. We utilized diagnostic codes from inpatient, emergency department, outpatient clinics, and telephone calls. We identified fever using ICD 9 code 780.6, recorded temperature ⩾101 degree Fahrenheit, or parental report.
RESULTS
The database contained the starting and ending date of each pregnancy and basic demographic characteristics of mothers and infants. There were 859,699 women and 873,753 children in the database as of January 2016. The proof of concept study included 148,699 infants. In a multivariable logistic regression analysis, Tdap vaccination during pregnancy was not associated with infant fever 0-3daysafter first dose of DTaP (adjusted odds ratio=0.92, 95% CI 0.82-1.04).
CONCLUSION
The KPNC pregnancy database can be used for studies investigating exposure during pregnancy and outcomes in mothers and/or infants, particularly monitoring vaccine safety and effectiveness.
Topics: Adult; California; Cohort Studies; Databases, Factual; Diphtheria; Diphtheria-Tetanus-acellular Pertussis Vaccines; Female; Humans; Infant; Infant, Newborn; Insurance, Health; Logistic Models; Pertussis Vaccine; Postpartum Period; Pregnancy; Pregnant Women; Proof of Concept Study; Retrospective Studies; Tetanus; Vaccination; Vaccines; Whooping Cough; Young Adult
PubMed: 27727029
DOI: 10.1016/j.vaccine.2016.10.006 -
A report from the endocrine society's 94th annual meeting & expo (June 23-26 - Houston, Texas, USA).Drugs of Today (Barcelona, Spain : 1998) Sep 2012At temperatures above 100 degrees Fahrenheit, but chilly air conditioning inside the George R. Brown convention center, Houston was the endocrine capital of America...
At temperatures above 100 degrees Fahrenheit, but chilly air conditioning inside the George R. Brown convention center, Houston was the endocrine capital of America during June 2012, with the ENDO EXPO 2012 meeting calling attendees from all the states and abroad. Endocrinology is a highly varied specialty, ranging from hormonal disturbances of the pituitary (and in fact acromegaly and Cushing's syndrome were among the stars of this year's meeting therapy-wise) to diabetes, female hormonal disorders and endocrine-mediated malignancies, to mention only a few. New and investigational treatments for these conditions are summarized in the following report, based on the oral and poster presentations during the meeting.
Topics: Adrenal Gland Diseases; Diabetes Mellitus; Endocrine System Diseases; Humans; Parathyroid Diseases; Pituitary Diseases; Texas; Thyroid Diseases
PubMed: 23032802
DOI: 10.1358/dot.2012.48.9.1871573 -
Clinical Pediatrics Apr 1991This study was designed to determine if temperature readings using a new tympanic thermometer are affected by otitis media. These readings were also compared to a rectal... (Comparative Study)
Comparative Study
This study was designed to determine if temperature readings using a new tympanic thermometer are affected by otitis media. These readings were also compared to a rectal or oral temperature. Eighty-four children with unilateral suppurative or non-suppurative otitis media diagnosed clinically by their pediatricians were enrolled in the study. Temperatures were measured in both ears using the Thermoscan PRO-1 Instant Thermometer and rectally or orally by a glass or electronic predictive thermometer. For 67 children with unilateral suppurative otitis media the mean temperature in infected ears was 0.38 degrees Fahrenheit higher than in uninfected ears (p = .005). Neither temperatures measured in affected nor those from unaffected ears differed significantly from oral or rectal control readings. For 17 children with unilateral non-suppurative otitis media there was no statistically significant difference between temperatures in affected and unaffected ears or between the temperatures in either ear and the oral or rectal control. Our data show that temperatures taken in ears with suppurative otitis media are slightly higher than those in normal ears. This difference is of minimal clinical significance and does not affect the accuracy when compared to oral or rectal control readings.
Topics: Body Temperature; Child; Child, Preschool; Equipment Design; Fever; Humans; Infant; Infrared Rays; Mouth; Otitis Media with Effusion; Otitis Media, Suppurative; Rectum; Thermometers; Tympanic Membrane
PubMed: 2029819
DOI: 10.1177/0009922891030004S13 -
Journal of Obstetric, Gynecologic, and... 1997Two common natural family planning (NFP) methods are the ovulation method based on characteristics of cervical mucus and the symptothermal method based on changes in...
Two common natural family planning (NFP) methods are the ovulation method based on characteristics of cervical mucus and the symptothermal method based on changes in cervical mucus, basal body temperature, and the cervix. Both methods are effective when used correctly. Nurses should understand the principles of NFP and introduce these methods in discussions of family planning options. Interested clients should be referred to a certified NFP instructor for education and supervision.
Topics: Body Temperature; Cervix Uteri; Female; Fertility; Humans; Maternal-Child Nursing; Natural Family Planning Methods
PubMed: 9395972
DOI: 10.1111/j.1552-6909.1997.tb02738.x