Kikuchi-Fujimoto Disease: A Differential for When It is Not Systemic Lupus Erythematosus.

Kikuchi-Fujimoto disease (KFD) is a rare and benign disease process that is characterized by fever and lymphadenopathy that was first described in young Japanese women in the early 1970s. Knowledge of KFD is important as it can often mimic other causes of lymphadenopathy including systemic lupus erythematosus (SLE) or malignancies, and this can lead to invasive diagnostic testing and even treatments that can be avoided. The etiology and exact mechanism by which KFD develops is not fully understood at this time, but is thought to be an immune response of T cells and histiocytes to viral or bacterial infections. We present a 35-year-old African-American woman who was referred to the rheumatology clinic by our colleagues in the breast clinic with new onset right axillary lymphadenopathy and abnormal serologic testing with the suspicion of SLE after a malignancy had been ruled out.

The taphonomic impact of scavenger guilds in southern Quebec during summer and fall in two distinct habitats.

Decomposition of human remains is a complex process impacted by many intrinsic and extrinsic factors. A less-studied extrinsic factor in forensic taphonomy are the scavengers that consume soft and hard tissue. Scavengers physically degrade and remove soft tissue, disperse, and destroy skeletal elements, which can make locating remains challenging. While invertebrate activity has been largely investigated, there is limited quantitative data available on vertebrate activity, particularly in Canada. This study aimed to determine which species (vertebrate and invertebrate) belong to the scavenger guilds in southern Quebec, and their potential taphonomic impact on the decomposition process. Two independent trials were conducted in 2020 using pig carcasses: one during summer in a forest habitat and one during fall in a grassland habitat. Each carcass was placed a minimum 100 m apart in semi-rural land. Vertebrate scavenger activity was recorded by continuous surveillance using trail cameras. Carcasses were also regularly visited to monitor the decomposition process and the activity of invertebrate scavengers. Overall, the vertebrate scavenger guilds included a narrow range of corvids, turkey vultures, coyotes, and skunks. The intensity of vertebrate scavengers was greater in the grassland habitat (fall), while the intensity of invertebrate scavengers was greater in the forest habitat (summer). With the exception of invertebrate scavengers, very few species visited during the fresh stage of decomposition, and the probability of body displacement increased as decomposition progressed. These results identify which scavengers have the greatest taphonomic impact and highlight the importance of incorporating scavenger impact when searching for human remains.

Challenges Related to Three Cases of Fatal Intoxication to Multiple Novel Synthetic Opioids.

In the last two decades, a large increase in opioid overdose death rates has been recorded in North America. This phenomenon, related to the misuse of prescription opioids, has been dubbed an "opioids crisis". Recent years have seen the entrance of novel synthetic opioids (NSO) on the market, compounding the fatal intoxications issue. This brings several challenges for forensic toxicology laboratories: an increased number of cases, a large number of novel structurally similar compounds to include in screening analytical methods, the low concentration of drugs in biological fluids, and the challenging interpretation in the absence of sufficient literature. Three cases of fatal intoxication highlighting those challenges are presented, complete with post-mortem concentrations in cardiac blood, femoral blood and urine. Toxicological screening and quantitative analyses were performed on the biological specimens. In the first and second cases, furanylfentanyl, U-47700 and 4-anilino-N-phenethylpiperidine (4-ANPP) were detected at similar concentrations in cardiac blood. In the third case, a total of seventeen different NSO were detected. All intoxications showed a combination of NSO and other drugs. These three cases appear to be the harbinger of an increased NSO prevalence in the province of Québec, Canada.

Subclavian and axillary vessel anatomy: a prospective observational ultrasound study.

PURPOSE: The primary objective of this study was to define the ultrasound-derived anatomy of the axillary/subclavian vessels. As a secondary objective, we evaluated the relationship between the vascular anatomy and demographic, anthropometric, and hemodynamic data of patients. METHODS: This observational anatomical study used bedside ultrasound with 150 cardiac surgical patients in the operating room. Bilateral axillary and subclavian anatomy was determined using a high-frequency ultrasound probe with fixed reference points. Images were recorded and analyzed, and correlation with demographic, anthropometric, and hemodynamic data was performed. RESULTS: The images were adequate to evaluate potential anatomical variations in 97.4% of patients with a body mass index as high as 46.4 kg·m-2. The mean (standard deviation) diameter of the axillary vein was 1.2 (0.3) cm on the right side and 1.1 (0.2) cm on the left side. The dimensions of the axillary vein were larger on the right side in 69% of patients. The vein was located directly over the artery in the mid-clavicular view in 67% of the patients and in lateral-clavicular view in only 7% of the patients. As we moved the probe laterally, the vein was lateralized in relation to the artery in 89% of patients. There was no significant correlation between the hemodynamic data and vessel size, although direct correlation was found between body mass index and the depth of the vessel (P < 0.001). The axillary vein area was smaller in females than in males (P < 0.002), and in 4% of patients, the axillary vein was in an aberrant position. CONCLUSIONS: In patients undergoing cardiac surgery, axillary vessel anatomy varied considerably, and the patients' hemodynamics could not predict the size of the axillary vessels. Only the patients' weight correlated moderately with the depth of the vein.

Ultrasound guidance for internal jugular vein cannulation: Continuing Professional Development.

PURPOSE: The objective of this continuing professional development module is to describe the role of ultrasound for central venous catheterization and to specify its benefits and limitations. Although ultrasound techniques are useful for all central venous access sites, the focus of this module is on the internal jugular vein approach. PRINCIPAL FINDINGS: In recent years, several studies were published on the benefits of ultrasound use for central venous catheterization. This technique has evolved rapidly due to improvements in the equipment and technology available. Ultrasound helps to detect the anatomical variants of the internal jugular vein. The typical anterolateral position of the internal jugular vein with respect to the carotid is found in only 9-92% of cases. Ultrasound guidance reduces the rate of mechanical, infectious, and thrombotic complications by 57%, and it also reduces the failure rate by 86%. Cost-benefit analyses show that the cost of ultrasound equipment is compensated by the decrease in the expenses associated with the treatment of complications. In this article, we will review the history of ultrasound guidance as well as the reasons that account for its superiority over the classical anatomical landmark technique. We will describe the equipment needed for central venous catheterization as well as the various methods to visualize with ultrasound. CONCLUSION: To improve patient safety, we recommend the use of ultrasound for central venous catheterization using the internal jugular approach.