Oral foreign body granuloma: unusual presentation of a rare adverse reaction to permanent injectable cosmetic filler

COSTA MIGUEL, M. C.; NONAKA, C. F. W.; GERMANO, A. R.; SOUZA, L. B.; SOUZA, L. B. Oral foreign body granuloma: unusual presentation of a rare adverse reaction to permanent injectable cosmetic filler. International journal of oral and maxillofacial surgery, v. 38, p. 385-387, 2009.

Association between vaginal bacterial microbiota and the presence and clinical presentation of vulvovaginal candidiasis

Thesis (Master's)--University of Washington, 2016-08

Information Presentation Features and Comprehensibility of Hospital Report Cards: Design Analysis and Online Survey Among Users

Background: Improving the transparency of information about the quality of health care providers is one way to improve health care quality. It is assumed that Internet information steers patients toward better-performing health care providers and will motivate providers to improve quality. However, the effect of public reporting on hospital quality is still small. One of the reasons is that users find it difficult to understand the formats in which information is presented. Objective: We analyzed the presentation of risk-adjusted mortality rate (RAMR) for coronary angiography in the 10 most commonly used German public report cards to analyze the impact of information presentation features on their comprehensibility. We wanted to determine which information presentation features were utilized, were preferred by users, led to better comprehension, and had similar effects to those reported in evidence-based recommendations described in the literature. Methods: The study consisted of 5 steps: (1) identification of best-practice evidence about the presentation of information on hospital report cards; (2) selection of a single risk-adjusted quality indicator; (3) selection of a sample of designs adopted by German public report cards; (4) identification of the information presentation elements used in public reporting initiatives in Germany; and (5) an online panel completed an online questionnaire that was conducted to determine if respondents were able to identify the hospital with the lowest RAMR and if respondents’ hospital choices were associated with particular information design elements. Results: Evidence-based recommendations were made relating to the following information presentation features relevant to report cards: evaluative table with symbols, tables without symbols, bar charts, bar charts without symbols, bar charts with symbols, symbols, evaluative word labels, highlighting, order of providers, high values to indicate good performance, explicit statements of whether high or low values indicate good performance, and incomplete data (“N/A” as a value). When investigating the RAMR in a sample of 10 hospitals’ report cards, 7 of these information presentation features were identified. Of these, 5 information presentation features improved comprehensibility in a manner reported previously in literature. Conclusions: To our knowledge, this is the first study to systematically analyze the most commonly used public reporting card designs used in Germany. Best-practice evidence identified in international literature was in agreement with 5 findings about German report card designs: (1) avoid tables without symbols, (2) include bar charts with symbols, (3) state explicitly whether high or low values indicate good performance or provide a “good quality” range, (4) avoid incomplete data (N/A given as a value), and (5) rank hospitals by performance. However, these findings are preliminary and should be subject of further evaluation. The implementation of 4 of these recommendations should not present insurmountable obstacles. However, ranking hospitals by performance may present substantial difficulties.

Oral foreign body granuloma: unusual presentation of a rare adverse reaction to permanent injectable cosmetic filler

COSTA MIGUEL, M. C.; NONAKA, C. F. W.; GERMANO, A. R.; SOUZA, L. B.; SOUZA, L. B. Oral foreign body granuloma: unusual presentation of a rare adverse reaction to permanent injectable cosmetic filler. International journal of oral and maxillofacial surgery, v. 38, p. 385-387, 2009.

Whipple’s disease infection surgical treatment: presentation of a rare case and literature review

The Whipple’ Disease (W.D.) is a very rare disease with an incidence of 1 per 1.000.000 inhabitants; it is a systemic infection that may mimic a wide spectrum of clinical disorders, which may have a fatal outcome and affects mainly male 40-50 years old. The infective agent is an actinomycete, Tropheryma Whipplei (T.W.) that was isolated 100 years after first description by Wipple, and identified in macrophages of mucosa of the small intestine by biopsy which is characterized by periodic acid-Schiff-positive, products of the inner membrane of his polysaccharide bacterial cell wall. The multisystemic clinical manifestations evolve rapidly towards an organic decay characterized by weight loss, malabsorption, diarrhea, polyathralgia, opthalmoplegia, neuro-psychiatric disorders and sometimes associated to endocarditis. Early antibiotic treatment with trimethoprim and sulfometathaxazole reduces the fatal evolution of the disease. The authors present a rare experience about a female subject in which the clinical gastrointestinal signs were preceded by neuro-psychiatric disorders, and evolved into obstruction and intestinal perforation which required an emergency surgery with temporary ileostomy, recanalized only after adequate medical treatment with a full dose of antibiotic and resolution of clinical disease for the high risks of fistulae for the edema and lymphadenopathy of mucosa. The diagnosis was histologically examined by intestinal biopsy performed during surgery, which showed PAS-positive histiocytes, while PRC polymerase RNA was negative, which confirms the high sensibility of PAS positive and low specificity of RNA polymerase for T.W.

Delayed presentation of blunt duodenal injuries in children. Case report and review of literature

Background. Duodenal injuries are rare in children and classically present following a fall over the handle bar. Retroperitoneal location of the duodenum may lead to delay in diagnosis, and missed injuries are associated with increased morbidity and mortality. Case report. A 5-year-old child was admitted to the National Trauma Center, in Tirana (Albania), 28 hours after a Motor Vehicle Crash (MVC), complaining of mild abdominal pain. He was febrile (39°C) and had a white blood cells count of 18,000 mm3. On physical exam he had mild tenderness. Plain abdominal X-rays and Focused Abdominal Sonography for Trauma (FAST) were negative for free air or free fluid. The CT scan of the abdomen demonstrated free air and fluid in the retroperitoneal space. At laparatomy, a perforation of the second portion of the duodenum was found. A single layer suture repair of the duodenum with wide drainage was performed. The patient was discharged from the hospital tolerating oral feeding 8 days later. Conclusion. Duodenal injuries in children are rare. Most duodenal hematomas are managed non-operatively. This is a case of MCV with delayed presentation that was treated surgically for perforation successfully.

Cast nephropathy: an extremely rare renal presentation of Waldenström's macroglobulinaemia

Renal involvement in Waldenström's macroglobulinaemia (WM) is very unusual when compared to multiple myeloma. We report a case of a patient who developed anuric acute kidney injury secondary to cast nephropathy, dependent on high-flux haemodialysis. Complementary study revealed the presence of blood IgM monoclonal gammopathy and a massive bone marrow lymphoplasmacytic infiltration. There were no osteolytic lesions and no clinical signs/symptoms of hyperviscosity syndrome. The diagnosis of WM was established and a dexamethasone plus cyclophosphamide regime was started, in addition to plasmapheresis. The patient partially recovered renal function allowing haemodialysis and plasmapheresis withdrawal. He remained asymptomatic with a good response to chemotherapy and 12 months after his renal function remained stable. This is a rare clinical case in which WM presented as an IgM cast nephropathy, which in turn is an extremely rare renal presentation of this equally rare haematological disorder.

The “Great Masquerader" Strikes Again: Secondary Syphilis Presentation with Erythema Multiforme (EM)-Like Lesions

Syphilis is a sexually transmitted disease known to present with highly variable manifestations, especially when left untreated. Patients who present to Internal Medicine Departments with fever and a rash are always a diagnostic challenge since mild viral diseases and life-threatening bacterial infections may manifest themselves similarly. In the following case presentation, we describe a patient with 1 month’s duration of fever and rash on the palms of the hand and soles of the feet, in the form of erythema multiforme (EM)-like lesions. His disease was diagnosed as secondary syphilis, once again justifying its name: the “great masquerader".

Vasculitis, a Rare Presentation of a Post-Streptococcal Syndrome

Post-streptococcal vasculitis is not awell-recognized non-suppurative complication of Group A streptococcal infections. Seventeen-year-old male was admitted with palpable purpura in the limbs, ankle swelling, microscopic hematuria and elevated inflammation markers. After short remission period, an extensive exudative pleural effusion was identified. High anti-streptococcal antibodies titers were found. This report illustrates an atypical and rare presentation of a post-streptococcal syndrome.

Lie detection and children: Impact of the mode of presentation

Although a great deal of research has examined lie-detection among adults, little research has examined the differences between audio and visual mediums for deception among children. In the current study participants were presented (n = 42) with recordings of four children, each describing his/her experience of getting glasses. Two of the accounts were truthful, two were fabricated. Half of the participants were presented with videos, half were presented with audio-recordings. Following the presentation of each recording, participants responded to questions regarding the truthfulness of each child’s account. Results showed that when evaluating truth-tellers, participants’ lie-detection accuracy was significantly greater than chance. Within the video condition, non-parents were shown to report significantly more lie-related cues than parents. Several deception cues were shown to be related to lie-detection accuracy.

Epigastric Pain in Acute Renal Infarction: The Forgotten Presentation

Epigastric pain is a manifestation of several medical and surgical conditions. However, when persistent epigastric pain is associated with microscopic or frank haematuria and elevated lactate dehydrogenase (LDH), especially in patients with increased risk of thromboembolic events, acute renal infarction (ARI) should be considered. We report the case of a 77-year-old male patient who presented with sudden persistent epigastric pain and elevated LDH who was found to have atrial fibrillation. The patient was diagnosed with ARI. ARI is not usually a typical differential diagnosis in patients with persistent epigastric pain and elevated LDH in whom the risk of thromboembolic events is high. Thus, physicians should perform a contrast-enhanced CT scan as early as possible to rule out or confirm renal infarction.

Separating deviant and non-deviant sexual preferences with a dual-target rapid serial visual presentation task

Forskning visar att avvikande sexuell preferens (ASP) är en av de mest centrala prediktorerna för återfall i sexualbrott. Eftersom det är viktigt att det i juridiskt beslutsfattande och behandling av sexualförbrytare finns valida och standardiserade verktyg att tillgå för bedömning av ASP, har forskningen under de senaste åren fokuserats på uppmärksamhetsbaserade metoder. Syftet med avhandlingen var att förbättra uppmärksamhetsbaserade metoder genom utvecklingen av en s.k. Rapid Serial Visual Presentation (dtRSVP) metod för att identifiera ASP. Innan vi testade sampel med sexualbrottslingar så genomförde vi tre studier för att kalibrera förfarandena. I dessa studier undersökte vi möjligheten att differentiera mellan homosexuella och heterosexuella män och hur enkelt deltagarna kunde fuska. Dessutom skapade vi en ny uppsättning standardiserade stimuli för bedömningen av pedofilt sexuellt intresse (Virtual People Set, VPS). I skapandet av stimuli togs de etiska och juridiska problemen i beaktande så långt som möjligt. När vi använde dtRSVP som mätningsförfarande för att skilja åt sexuellläggning i ett sampel av homosexuella och heterosexuella män fann vi att sexuellt relevanta stimuli påverkade informationsbehandlingen på ett förutsägbart sätt. Förfarandet hade en god förmåga att skilja sexuella preferenser mellan grupperna och förfarandet var svårt att påverka genom att fuska. När vi använde dtRSVP som mätningsförfarande för att identifiera avvikande sexuell läggning bland dömda sexbrottslingar fann vi att de visade en annorlunda bearbetning av sexuella stimuli jämfört med andra deltagare och att dessa skillnader var i de förväntade riktningarna. Det var däremot svårt att dra några slutsatser angående denna mätmetods förmåga att skilja mellan grupperna pedofiler och icke-pedofiler. Slutligen fann vi att VPS verkar vara ett användbart stimuluspaket för experimentell forskning om pedofilt sexuellt intresse. ---------------------------------------------------- Tutkimuksien mukaan poikkeava seksuaalinen mieltymys (PSM) on yksi seksuaalirikoksen uusimisen keskeisimmistä ennustajista. Oikeudellisessa päätöksenteossa ja seksuaalirikollisten hoidossa on tärkeää, että on käytettävissä kelvollisia ja standardisoituja välineitä PSM:n arvioinnissa. Sen vuoksi on tutkimuksissa viime vuosina keskitytty huomaavaisuuteen perustuviin menetelmiin. Tämän tutkielman tarkoitus oli parantaa huomaavaisuuteen perustuvia menetelmiä kehittämällä nk. Rapid Serial Visual Presentation (dtRSVP) menetelmän. Kalibroidakseen menettelytapoja suoritettiin kolme tutkimusta ennen kuin tutkittiin koeryhmää, johon kuuluvat seksuaalirikollisia. Näissä tutkimuksissa tutkittiin mahdollisuutta erotella homoseksuaalisia ja heteroseksuaalisia miehiä ja tutkittiin missä määrin osallistujien oli helppo huiputtaa. Sen lisäksi, pedofiilisen seksuaalisen mieltymyksen arviointia varten kehitettiin uutta sarjaa standardisoituja virikkeitä (Virtual People Set, VPS). Kehitettäessä virikkeitä otettiin mahdollisimman pitkälti huomioon eettisiä ja oikeudellisia ongelmia. Käytettäessä dtRSVP mittausmenetelmää erotellakseen homo- ja heteroseksuaalista suuntautumista havaitsimme, että seksuaaliset virikkeet vaikuttivat tietojenkäsittelyyn ennustettavalla tavalla. Menettelytavan avulla pystyttiin erotella koeryhmässä olevia seksuaalisia mieltymyksiä ja menettelytapaan oli vaikeaa vaikuttaa huijaamalla. Käytettäessä dtRSVP mittausmenetelmää tunnistaakseen poikkeavaa seksuaalista mieltymystä tuomittujen seksuaalirikollisten keskenään havaitsimme, että he osoittivat erilaista käsittelyä seksuaalisista virikkeistä toisiin osallistujiin verrattuna ja tulokset olivat ennustettavia. Silti oli vaikeaa tehdä johtopäätöksiä mittausmenetelmän kyvystä erotella ryhmiä pedofiilisiä ja ei-pedofiilisiä miehiä. Lopuksi havaitsimme, että VPS näyttää olevan käyttökelpoinen stimulussarja pedofiilisen seksuaalisen mieltymyksen kokeellisissa tutkimuksissa.

Eosinophilic Fasciitis: an Atypical Presentation of a Rare Disease

Objectives: We report an atypical presentation of eosinophilic fasciitis and provide a concise overview of the literature. Materials and Methods: Clinical and laboratory findings in a patient presenting with fever and skin induration were recorded. A deep muscle biopsy was performed in order to confirm the diagnosis. Results: A spontaneous favourable clinical and radiological evolution was observed. Conclusion: The diagnosis of eosinophilic fasciitis is challenging due to the lack of pathognomonic signs and symptoms. As spontaneous resolution has been described, watchful waiting is defendable depending on the clinical presentation. Although magnetic resonance imaging (MRI) can be useful in establishing the diagnosis, a deep muscle biopsy remains the gold standard diagnostic tool.

Seizure and Profound Hypokalemia: Unusual Presentation of Primary Hyperparathyroidism

A 68-year-old man was admitted because of tonic–clonic convulsion. He had been receiving 200 mg itraconazole for 10 days. He had hypokalaemia (2.2 mEq/l), hypercalcaemia (Cacorr 11.0 mg/dl) and elevated serum parathyroid hormone (PTH, 95 pg/ml). Ultrasound examination of the neck revealed a low echoic tumour. Cessation of itraconazole and fluid supplementation eradicated clinical symptoms and profound hypokalaemia, but serum potassium remained low normal (3.4 mEq/l) and the mild hypercalcaemia and elevated PTH were unchanged. To conclude, a small amount of itraconazole (200 mg) precipitated profound hypokalaemia and seizure in a patient with mild hyperparathyroidism and low normal serum potassium.