Dedifferentiated liposarcoma of the spermatic cord.

A man in his 60s presented to an outside hospital with persistent groin pain and a scrotal mass which was thought to be a recurrent hernia. Three months after initial presentation, the patient was found to have dedifferentiated liposarcoma (LPS) of the spermatic cord. LPS of the spermatic cord is a rare entity; however, clinicians should have LPS on the differential diagnosis especially in men with recurrent scrotal pain and mass. If unrecognised, LPS is associated with a high degree of morbidity and mortality. LPS can be subdivided into well-differentiated LPS, dedifferentiated LPS, myxoid LPS and pleomorphic LPS. In patients with advanced or metastatic LPS, chemotherapy consisting of Adriamycin, ifosfamide and mesna is used despite LPS being relatively chemoresistant. Therapies inhibiting mouse double minute 2 homologue, an oncoprotein that is a negative regulator of the tumour suppressor p53, appear to be promising in preclinical trials.

Oedema: a rare complication of plasma donation in an adolescent female.

Plasma donation has been widely used to recover medically vital components, such as immunoglobulins and clotting factors. Although generally well tolerated, there have been reports in the medical literature of reactions following blood and plasma donation. We present the first case, to our knowledge, of lower extremity oedema as the only complication noted following plasma donation in an adolescent female without underlying risk factors. Laboratory evaluation was unremarkable with the exception of decreased total serum protein. Symptoms resolved with conservative management and avoidance of plasma donation. Our case highlights the importance of screening for all sources of income in adolescents to assess for health disparities, evaluate risk factors and provide appropriate guidance.

Recurrent small bowel obstruction as a rare presentation of undiagnosed sarcoidosis.

Sarcoidosis is an immune-mediated inflammatory disorder with unknown aetiology that is marked by non-caseating granulomas in affected organs. Pulmonary sarcoidosis is the most common manifestation, but gastrointestinal involvement, particularly in the small bowel, is exceedingly rare. While symptom-driven treatment guidelines that are steroid based are well established for pulmonary and few extrapulmonary manifestations (ie, cardiac, neurologic, renal), gastrointestinal sarcoidosis treatment is largely extrapolation with optimal management under investigation. Additionally, few works document small bowel obstruction related to small bowel sarcoidosis. We present a case of short-interval recurrent small bowel obstruction in a man in his sixties that revealed newly diagnosed sarcoidosis with suspected small bowel involvement who never underwent steroid therapy. The patient exhibited gastrointestinal symptoms, despite asymptomatic pulmonary disease and a course of prednisone may have reduced his risk of recurrence. We also review suggested gastrointestinal sarcoidosis treatment and surveillance guidelines with focus on the small bowel.

Multisystem organ failure secondary to acute generalised exanthematous pustulosis (AGEP) with atypical presentation resembling septic shock.

A woman was admitted for sepsis secondary to cellulitis. After clinical improvement of sepsis, non-follicular small pustules were observed on the trunk, limbs and face while vesicles/bullae and skin exfoliation were noted on upper extremities. Larger systemic manifestations included fever, hypertension and tachycardia. Laboratory results revealed neutrophilic leukocytosis, eosinophilia, mild transaminitis and acute renal failure. Despite treatment for potential sepsis and discontinuation of offending agents, her condition worsened leading to haemodynamic instability and renal failure requiring vasopressor support, intubation and continuous veno-venous haemodialysis. Skin biopsy revealed a diagnosis of acute generalised exanthematous pustulosis (AGEP), a rare condition usually caused by antibiotic treatment. The suspected offending drug was clindamycin, with possible combined effects by metronidazole and/or vancomycin. Improvement of skin manifestations were seen within 48 hours of starting systemic steroids. Here, we present an uncharacteristic case of AGEP clinically presenting with atypical skin lesions, severe systemic involvement mimicking septic shock, which culminated in multisystem organ failure.

A retrospective, cohort study of the prevalence and risk factors of oral burning in patients with dry mouth.

OBJECTIVES: The aims of this study were to evaluate the prevalence of oral burning in a dry mouth cohort of patients and to determine associated factors. STUDY DESIGN: A retrospective cohort study was conducted by reviewing the charts of 170 patients who presented to Carolinas Medical Center's Department of Oral Medicine from January 2004 to June 2009. Information collected from their charts was extensive. RESULTS: Forty percent (68 of 170) of dry mouth patients had a concomitant complaint of oral burning. Sixty-four were female and 4 were male. The mean age was 61.1 years (range 25-89). Cofactors associated with oral burning included age (OR 1.03, CI 1.00-1.05, P = .028) and use of herbal medications (OR .26, CI .10-.67, P = .005). CONCLUSIONS: Oral burning is often concomitant with oral dryness. Targeting factors associated with oral dryness may help alleviate an oral burning complaint in select populations.