Evaluation of skull bone viability and effect of early surgical intervention in electrical contact burns using 18 F-Sodium Fluoride PET-CT imaging.

OBJECTIVE: Electrical contact burns of the scalp cause serious morbidity and mortality. Early necrotic bone debridement and flap cover are crucial for successful wound closure. 18 F Sodium Fluoride (NaF), with high bone-to-soft tissue activity ratio, is useful for bone viability assessment. This study evaluated the role of 18 F NaF PET-computed tomography (CT) in objectively defining the extent and depth of nonviable calvarial bone, to guide adequate bone debridement. METHOD: Of 20 patients referred to our institute with electrical contact burns of the scalp during a 2-year period, 15 were enrolled in the study. Two weeks after the initial management, tracer uptake pattern was noted on 18 F NaF PET-CT of the head and exposed bone measured. Surgical bone debridement was based on scan findings, followed by wound closure. All patients underwent clinical evaluation and follow-up scan 3 months after surgery. RESULTS: Eight patients showed a central photopenic area in the exposed bone (maximum standardized uptake value [SUVmax] of 0.76 ± 0.14 with mean maximum dimensions 4.10 ± 1.76/2.67 ± 1.54 cm). High tracer uptake (SUVmax, 9.66 ± 6.03) was seen peripheral to the exposed bone (mean maximum dimensions, 8.14 ± 3.03/4.75 ± 1.61 cm). Postoperatively, there was no significant change in tracer uptake in the central debrided region or peri-debridement bone area under the flap. Clinically all patients showed a well-healed flap. CONCLUSION: 18 F NaF PET-CT appears useful for objective evaluation of skull bone viability and planning necrotic bone debridement in patients with electrical contact burns. However, additional studies with longer patient follow-up are required to validate these results.

A Rare Case of Groove Pancreatitis.

One of the most commonly diagnosed gastrointestinal disorders in the inpatient hospitalization setting is pancreatitis. It is increasingly common in the western world and the incidence is only growing over the last decade. The most common causes of pancreatitis are gallstones, alcohol, and hypertriglyceridemia. However, we present a very unusual case of pancreatitis caused by a unique anatomical obstruction called groove pancreatitis (GP). It is extremely infrequent as there is no prevalence, and can often be mistaken for pancreatic cancer. We explore the case of a 36-year-old male with no significant risk factors of pancreatitis presenting with abdominal pain and was found to have groove pancreatitis.

The First Report of Cutaneous Nocardia Concava Infection in the United States.

This is a case report presenting a rare disease, cutaneous Nocardia concava infection. There are currently only five published case studies worldwide describing infections caused by N. concava, and all of them occurred in Far East Asian countries (Japan, China, and Korea). Three of the reported cases were cutaneous infection cases. This is the sixth case to be reported in the world and the first in the United States. A 75-year-old Caucasian female was admitted to a community hospital with recurring cutaneous lesions for four months. Biopsy demonstrated the presence of Nocardia concava, confirmed by DNA sequencing on the hps65 gene. Treatment was achieved with sulfamethoxazole-trimethoprim. This case report creates awareness for family physicians to consider that cutaneous nocardiosis may mimic the cutaneous lesions of sporotrichosis. If a patient fails multiple treatment regimens, advanced microbiological evaluation methods such as DNA sequencing should be considered.

Rhabdomyolysis: A Rare Adverse Effect of Levetiracetam.

Levetiracetam is an anti-epileptic that works at the synapse and binds synapse vesicle protein 2A, thereby controlling the release of neurotransmitters. Its side effects mainly include somnolence, headache, fatigue, dizziness, vomiting, and behavioral alterations. Rhabdomyolysis is a rare adverse effect of levetiracetam. The underlying pathophysiology of this adverse effect is unknown. Our patient is a 42-year-old male who was brought to the hospital with a complaint of generalized tonic-clonic seizures and urinary incontinence. His symptoms were caused by hyponatremia. Levetiracetam was started for seizure prevention along with management for hyponatremia. His creatine phosphokinase levels increased on the third day of admission to 30,000 U/L. Four days after the discontinuation of levetiracetam and with the institution of supportive therapy, the patient's rhabdomyolysis resolved.