G-CSF-induced TIPIC syndrome and large vessel vasculitis: A case report.

Key Clinical Message: We report a rare adverse event of transient perivascular inflammation of the carotid artery syndrome induced by granulocyte colony-stimulating factor injections. Recognition of this syndrome is important for physicians, to avoid the exposure of the causative medication, rule out differential diagnosis and delay the use of corticosteroids given the spontaneous improvement after discontinuation of the causative medication. Abstract: A 73 year-old Caucasian woman presented with odynophagia, carotidynia, and fever 5 days following a granulocyte colony-stimulating factor (G-CSF) injection for chemotherapy-induced neutropenia in the setting of myelodysplastic syndrome. Examination showed painful swelling of the neck. Lab results showed inflammation with CRP 328 mg/L. A CT-scan revealed tissue infiltration thickening surrounding the left internal carotid artery, the carotid bifurcation, and the common carotid artery, as well as circumferential thickening of the aortic arch. Ultrasound of the left internal carotid artery found isoechoic wall thickening. Symptoms drastically improved without steroids in a short time period. Horton's disease, Takayasu's diseases, and infectious vasculitis were not retained due to the short time delay of symptoms onset, atypical echogenicity, and spontaneous improvement. A diagnosis of G-CSF-induced large vessel vasculitis transient perivascular inflammation of the carotid artery (TIPIC) syndrome was made. Seven days later, ultrasound control showed diminished thickening infiltration. G-CSF TIPIC is a rare adverse event that should be kept in mind in patients under G-CSF.

Optimal Management With Radical Resection of Obstructive Primary Chondrosarcoma of the Trachea.

We report 2 cases of chondrosarcoma of the trachea. This etiology of tracheal tumors is exceptional, and only a few cases have been reported so far. The optimal management for these 2 cases was challenging. First an interventional bronchoscopy was required for biopsy and to prevent airway obstruction. Second a radical en bloc resection with free margins was performed through a sternotomy in the first case and by a cervicotomy in the second case. Fifty and 6 months after surgery the 2 patients are alive with no local or distant recurrence.

Rapid screening of COVID-19 patients using white blood cell scattergrams, a study on 381 patients.

Complementary tools are warranted to increase the sensitivity of the initial testing for COVID-19. We identified a specific 'sandglass' aspect on the white blood cell scattergram of COVID-19 patients reflecting the presence of circulating plasmacytoid lymphocytes. Patients were dichotomized as COVID-19-positive or -negative based on reverse transcriptase polymerase chain reaction (RT-PCR) and chest computed tomography (CT) scan results. Sensitivity and specificity of the 'sandglass' aspect were 85·9% and 83·5% respectively. The positive predictive value was 94·3%. Our findings provide a non-invasive and simple tool to quickly categorize symptomatic patients as either COVID-19-probable or -improbable especially when RT-PCR and/or chest CT are not rapidly available.

The Plasmair Decontamination System Is Protective Against Invasive Aspergillosis in Neutropenic Patients.

OBJECTIVE Invasive aspergillosis (IA) is a rare but severe infection caused by Aspergillus spp. that often develops in immunocompromised patients. Lethality remains high in this population. Therefore, preventive strategies are of key importance. The impact of a mobile air decontamination system (Plasmair, AirInSpace, Montigny-le-Bretonneux, France) on the incidence of IA in neutropenic patients was evaluated in this study. DESIGN Retrospective cohort study METHODS Patients with chemotherapy-induced neutropenia lasting 7 days or more were included over a 2-year period. Cases of IA were confirmed using the revised European Organization for Research and Treatment of Cancer (EORTC) criteria. We took advantage of a partial installation of Plasmair systems in the hematology intensive care unit during this period to compare patients treated in Plasmair-equipped versus non-equipped rooms. Patients were assigned to Plasmair-equipped or non-equipped rooms depending only on bed availability. Differences in IA incidence in both groups were compared using Fisher's exact test, and a multivariate analysis was performed to take into account potential confounding factors. RESULTS Data from 156 evaluable patients were available. Both groups were homogenous in terms of age, gender, hematological diagnosis, duration of neutropenia, and prophylaxis. A total of 11 cases of probable IA were diagnosed: 10 in patients in non-equipped rooms and only 1 patient in a Plasmair-equipped room. The odds of developing IA were much lower for patients hospitalized in Plasmair-equipped rooms than for patients in non-equipped rooms (P=.02; odds ratio [OR] =0.11; 95% confidence interval [CI], 0.00-0.84). CONCLUSION In this study, Plasmair demonstrated a major impact in reducing the incidence of IA in neutropenic patients with hematologic malignancies. Infect Control Hosp Epidemiol 2016;37:845-851.

Lysergic acid amide-induced posterior reversible encephalopathy syndrome with status epilepticus.

INTRODUCTION: Posterior reversible encephalopathy syndrome (PRES) is known to occur in association with several substances. However, lysergic acid amide (LSA) is not among the previously reported causes of PRES. METHODS: We report on a patient with PRES presenting as convulsive status epilepticus associated with hypertensive encephalopathy after LSA ingestion. Magnetic resonance imaging was performed and catecholamine metabolites assayed. RESULTS: The patient achieved a full recovery after aggressive antihypertensive therapy and intravenous anticonvulsivant therapy. The clinical history, blood and urinary catecholamine levels, and response to treatment strongly suggest that PRES was induced by LSA. CONCLUSION: LSA, a hallucinogenic agent chiefly used for recreational purposes, should be added to the list of causes of PRES.

[Preoperative selective embolization of a renal angiomyolipoma allowing conservative surgery]. / Embolisation sélective pré-opératoire d'un angiomyolipome rénal permettant une chirurgie conservatrice.

UNLABELLED: The authors report the case of a 42-year-old woman presenting with a mass in the left hypochondrium, in whom preoperative haemostatic embolization allowed subsequent partial nephrectomy. Ultrasound, helical CT and magnetic resonance imaging showed a large mass (30 cm in diameter) arising from the left kidney. This mass presented characteristics in favour of an essentially fatty lesion compatible with angiomyolipoma, supplied by a large midrenal transcapsular artery. Partial proximal haemostatic selective renal embolization using metal coils was performed immediately prior to surgery. Preoperative embolization rapidly allowed complete resection of the tumour Histological examination confirmed the diagnosis of angiomyolipoma. CONCLUSION: This cases illustrates the role of preoperative embolization to facilitate conservative surgical management of a large benign tumour.

Occlusive arterial disease of abdominal aorta and lower extremities: comparison of helical CT angiography with transcatheter angiography.

The purpose of this study was to evaluate helical CT angiography in the assessment of occlusive arterial disease of abdominal aorta and the lower extremities. Sixteen patients underwent both transcatheter angiography and helical CT. Helical CT was inconclusive in 6.2% of segments whereas angiography was inconclusive in 5%. The overall sensitivity of helical CT was 91% and specificity 93%. Segmental analysis found a sensitivity of 43% in infrapopliteal arteries, and a specificity of 86%.

Digital spot mammography using an add-on upright unit: diagnostic application in daily practice.

INTRODUCTION: To present the use of digital spot mammography (DSM) in a diagnostic practice. METHODS AND PATIENTS: Digital spot images of 779 women requiring a spot compression or a spot magnification view were collected. The digital images were acquired on a digital spot upright unit using a 61 mm x 61 mm field of view. Lesions reported included masses, calcifications, and areas of distortions. RESULTS: 1065 lesions required additional views with DSM. Lesions reported included masses (n = 113), masses and microcalcifications (n = 53), spiculated masses (n = 34), architectural distortions (n = 16), and microcalcifications (n = 849). DSMs were considered to be adequate in 97.7% of patients. Unsatisfactory exams resulted from difficulties encountered in targeting the area of interest at the beginning of our experience. CONCLUSION: DSM, most commonly used to perform interventional procedures, can also be used in a diagnostic practice taking advantage of post-processing of images not available with conventional spot compression and magnification.

Head and neck cancer patients with pulmonary nodules: value and role of CT-guided transthoracic needle aspiration biopsies.

BACKGROUND: To evaluate transthoracic needle aspiration biopsies of pulmonary lesions in patients with squamous cell cancer of head and neck. METHODS: Retrospective series of 85 patients with squamous cell cancer of head and neck cancer and pulmonary nodules who underwent CT-guided needle aspiration biopsy. RESULTS: Diagnostic samples were obtained in 85% of patients. There were 8 benign and 77 malignant lesions. Among the 73 proved cases, 4 were false-negative cases. CT-guided biopsy had an accuracy of 81%, a sensitivity of 94%, and a negative predictive value of 60%. Accuracies were 68% for lesions of 20 mm or smaller and 89% for lesions greater than 20 mm. In a subset of 45 solitary lesions, among 30 positive biopsies, 15 were categorized as primary malignancies, 3 as metastatic, and 12 as indeterminate malignancies. CONCLUSIONS: In head and neck cancer patients, the prevalence of thoracic malignancies is high when a pulmonary lesion is detected. CT-guided biopsy of pulmonary lesion is an accurate procedure. However, a third of positive biopsies were categorized as indeterminate malignancies.

Pneumomediastinum causing pneumoperitoneum during mechanical ventilation.

The causes of nonsurgical pneumoperitoneum include numerous diseases. We report here a case of nonsurgical pneumoperitoneum caused by benign pneumomediastinum during mechanical ventilation, and we discuss the anatomic pathways and the pathophysiologic mechanisms responsible for the development of this association.