Mononuclear syndrome with acute hepatitis diagnosed as Mycoplasma pneumoniae infection without lung involvement.

Although pneumonia is the hallmark of Mycoplasma pneumoniae infections, it has been associated with protean manifestations such as extrapulmonary involvement. Herein, a rare case of mononuclear syndrome with acute hepatitis and erythema multiforme revealed as M pneumoniae infection without lung involvement is reported. A 30-year-old man, previously healthy, presented with fever and rash with acute hepatitis: AST 603 IU/L, ALT 747 IU/L, prothrombin time 52%. Peripheral blood smears indicated monocytosis with atypical lymphocyte. Bone marrow biopsy revealed increased plasma cell infiltration. M pneumoniae infection was detected by serology testing. After treatment with macrolide, clinical symptoms and signs and serological tests were fully resolved. Diagnosis of this etiologic association is important when patients present with various clinical syndromes without pneumonia, because only specific antimicrobial therapy is effective against M pneumoniae.

Robotic interface for transabdominal division of the levators and pelvic floor reconstruction in abdominoperineal resection: a case report and technical description.

BACKGROUND: Extralevator abdominoperineal resection (APR) in a prone jackknife position was developed to avoid a positive circumferential resection margin, and its application led to lower rates of local recurrence. The paper describes a technique of robotic extralevator APR with transabdominal levator division followed by pelvic floor reconstruction with bilayered composite mesh. METHODS: A 42-year-old man with low rectal cancer required APR that was performed in a lithotomy position with transabdominal division of the levators. After the perineal phase, the robot was redocked and a bilayered composite mesh was sutured to the pelvic inlet using robotic needle drivers. RESULTS: The specimen had a cylindrical shape, and there was no surgical waist or perforation. Histology revealed a ypT2N0 tumor without circumferential margin involvement. CONCLUSIONS: The robotic interface can aid in APR by accurately transecting the levators from the top. Additionally, it allows suturing of mesh around the pelvic inlet to prevent perineal hernias. Copyright © 2014 John Wiley & Sons, Ltd.