Disseminate and Recurrent Infundibular Folliculitis: Case Report and Literature Review.

We retrospectively analyzed the clinical data of 1 case of disseminate and recurrent infundibular folliculitis (DRIF) in our hospital and 31 cases of DRIF reported in previous domestic and international studies. There were 32 cases, including 22 males and 10 females, with a mean age of onset of 24.72 ± 13.68 years. Skin lesions were more likely to occur on the trunk and proximal extremities and may involve the face, neck, and genitals. Typical histopathology revealed mild thickening and spongy edema of the spinous layer, different degrees of pigmentation increase in the basal layer, and mild to moderate spongy edema and inflammatory cell infiltration (predominantly lymphocytes and neutrophils) in the infundibulum and around the hair follicle. DRIF is a chronic disease more prevalent in young men of African descent and individuals with Fitzpatrick skin types 4-6. This disease is diagnosed based on clinical features and histopathology and is preferentially treated with retinoids.

Combination therapy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent leiomyomatosis peritonealis disseminata with endometriosis: A case report.

Background: Leiomyomatosis peritonealis disseminata (LPD) is a non-metastatic, homologous, multicentric benign disorder characterized by small leiomyomas scattered over the peritoneum and omentum. It is a rare and benign disease with invasive potential. LPD mainly attacks women of childbearing age but has also been reported in post-menopausal women, men, and young children. Non-specific clinical and imaging findings of LPD lead to difficult diagnoses and treatment. Case presentation: This study reports the case of a patient with recurrent LPD with endometriosis after multiple myomectomies and hysterectomy, who presented recurrent abdominal pain with progressive exacerbation. Imaging examinations showed irregular shadows in the pelvic cavity and multiple nodular changes in the peritoneum, which were considered malignant lesions. A solid mass sized 10 cm × 9 cm × 10 cm in the inferior pelvis and nodules scattered over the surface of pelvic and abdominal organs and the peritoneum were detected during the surgery. The patient was treated with cytoreductive surgery (CRS), peritonectomy, ovarian ablation, and hyperthermic intraperitoneal chemotherapy (HIPEC). The surgery was challenging, and the intraoperative bleeding reached 900 ml. However, the patient recovered well and achieved a tumor-free survival of 13 months. Conclusions: It was concluded that a combination of CRS, ovarectomy, and HIPEC might be one of the therapeutic strategies for recurrent LPD.

Transfollicular elimination of sebaceous glands in a patient with disseminate and recurrent infundibulofolliculitis.

Disseminate and recurrent infundibulofolliculitis (DRIF) is a rare form of folliculitis characterized by multiple papules widely distributed on the trunk and extremities. We present a 37-year-old man with confirmed DRIF complicated by transfollicular elimination of the sebaceous unit, an additional finding of DRIF that has rarely been reported.

18F-fluorodeoxyglucose positron emission tomography-computed tomography imaging of leiomyomatosis peritonealis disseminata.

Leiomyomatosis peritonealis disseminata (LPD) is a rare benign condition characterized by multiple smooth muscle implants in the peritoneal cavity. The clinical presentation is usually nonspecific abdominal discomfort and nontender abdominal mass. Preoperative imaging usually points to suggests malignancy due to its unusual location, but the diagnosis can only be confirmed by histopathological examination. We share 18F-Fluorodeoxyglucose positron emission tomography-computed tomography images of a 43-year-old woman diagnosed with LPD and briefly discuss the clinical aspects of this disease.

Diffuse intrathyroidal dissemination of papillary thyroid carcinoma with no stromal fibrosis at presentation: A pattern of aggressive differentiated thyroid carcinoma.

BACKGROUND: Multifocal Papillary thyroid carcinoma (PTC) is a very common condition. In certain cases, it is possible to find tens to hundreds of foci with a diffuse intrathyroidal spread in the whole thyroid with no stromal fibrosis. Herein, PTC with such features was nominated as diffuse disseminate variant (DDV) PTC. The aim of the present study was to investigate the histopathological characteristics, molecular features, and biological behavior of DDV and compare the characteristics of DDV to diffuse sclerosing variant (DSV) PTC. MATERIALS AND METHODS: Thirty-four DDV and 23 DSV cases were identified from consecutive surgical specimens diagnosed with PTC between 2014 and 2019. Targeted next-generation sequencing (NGS) was applied to investigate the mutation spectrum of DDV and DSV. RESULTS: DDV was commonly diagnosed in young patients and exhibited high rates of LNM (100 %), ETE (61.8 %), and LVI (44.1 %); however, they did not differ from DSV (P > 0.05). Male patients were more frequently diagnosed with DDV than with DSV (P < 0.001). The size of the largest tumor was significantly greater in DDV than in DSV patients (P = 0.008). In addition, BRAFV600E mutation was significantly higher in the DDV than in the DSV group (P < 0.001). The RET/PTC rearrangement was more frequent in DSV than in DDV patients; however, the difference was not statistically significant (P = 0.106). Moreover, DDV had a higher rate of recurrence compared to DSV treated with the same protocol (total thyroidectomy followed by radioactive iodine (RAI) treatment) (47.1 % and 8.7 %, P = 0.002). CONCLUSIONS: DDV should be regarded as a novel aggressive variant of PTC with distinct clinicopathological characteristics, aggressive biological behaviors, and a high recurrence.

Two-day assertive-case-management educational program for medical personnel to prevent suicide attempts: A multicenter pre-post observational study.

AIM: Suicide attempters have a high risk of repeated suicide attempts and completed suicide. There is evidence that assertive case management can reduce the incidence of recurrent suicidal behavior among suicide attempters. This study evaluated the effect of an assertive-case-management training program. METHODS: This multicenter, before-and-after study was conducted at 10 centers in Japan. Participants were 274 medical personnel. We used Japanese versions of the Attitudes to Suicide Prevention Scale, the Gatekeeper Self-Efficacy Scale, the Suicide Intervention Response Inventory (SIRI), and the Attitudes Toward Suicide Questionnaire. We evaluated the effects with one-sample t-tests, and examined prognosis factors with multivariable analysis. RESULTS: There were significant improvements between pre-training and post-training in the Attitudes to Suicide Prevention Scale (mean: -3.07, 95% confidence interval [CI]: -3.57 to -2.57, P < 0.001), the Gatekeeper Self-Efficacy Scale (mean: 10.40, 95%CI: 9.48 to 11.32, P < 0.001), SIRI-1 (appropriate responses; mean: 1.15, 95%CI: 0.89 to 1.42, P < 0.001), and SIRI-2 (different to the expert responses; mean: -4.78, 95%CI: -6.18 to -3.38, P < 0.001). Significant improvements were found on all Attitudes Toward Suicide Questionnaire subscale scores, except Unjustified Behavior. The effect of training was influenced by experience of suicide-prevention training and experience of working with suicidal patients. CONCLUSION: The training program (which was developed to implement and disseminate evidence-based suicide-prevention measures) improved attitudes, self-efficacy, and skills for suicide prevention among medical personnel. Specialized suicide-prevention training and experience with suicidal patients are valuable for enhancing positive attitudes and self-efficacy; furthermore, age and clinical experience alone are insufficient for these purposes.

Disseminate and Recurrent Infundibulofolliculitis.

Three patients, one female and two males, aged 18, 45, and 25 years, respectively, presented with the complaint of skin-colored papules interspersed with pustular lesions over the anterior and lateral aspect of the neck and upper chest for 2, 8, and 6 months, respectively. Histopathologically, mononuclear cell infiltrate centered over the infundibulum of the hair follicle was seen which confirmed the diagnosis of disseminate and recurrent infundibulofolliculitis. We report this case due to its rarity, especially in the Indian population in which less than five case reports have been published. We also report a specific pattern of lesions along the neck skin creases which can serve as an aid to increase the index of suspicion for diagnosing this entity.

Leyomiomatosis peritonealis disseminata associated with ovarian endometriosis in a patient submitted to hysteroscopic myomectomy.

OBJECTIVE: To describe laparoscopic management of a case of leyomiomatosis peritonealis disseminata associated with ovarian endometriosis. DESIGN: Surgical video article. SETTING: Academic hospital. PATIENT: We present a case of a 30-year-old woman referred to our clinic for abdominal and pelvic pain and dyspareunia. A hysteroscopic myomectomy was reported as previous surgical history. At ultrasound examination, a left ovarian cyst of 4 cm suspected for typical endometrioma and a mild hydroureteronephrosis of left kidney were revealed. The patient was scheduled for laparoscopic surgery. INTERVENTIONS: During laparoscopy, multiple nodules were found simulating widespread metastases involving colon, small bowel, omentum, right diaphragmatic dome, gastric surface, vesico-uterine area and abdominal peritoneum. Several biopsies and a peritoneal washing were performed, suspecting a peritoneal carcinomatosis. The histological frozen section examination revealed a possible benign disease, requiring further immunohistochemical study that diagnosed leiomyomatosis peritonealis. A second laparoscopy was then performed after one month. Enucleation of the left ovarian endometriotic cyst with classic stripping technique was performed. The left ureter was compressed by a fibrotic nodule of 5 cm that was isolated and removed. Operating time was 80 minutes. The postoperative course was uneventful and the patient was discharged on postoperative day 2. MAIN OUTCOME MEASURES: Description of a case of leiomyomatosis peritonealis disseminata in a patient with no previous history of intra-abdominal morcellation. RESULTS: The removal of the left ovarian endometriotic cyst and the periureteral nodule was successfully performed. The patient reported good health conditions without hydroureteronephrosis at six months follow up visit. CONCLUSIONS: Leiomyomatosis peritonealis disseminata is a rare clinical disorder characterized by proliferation of nodules, consisted by smooth muscle cells. The association of this condition with endometriosis has been described in other studies. Despite several medical therapies have been proposed (chemotherapy, aromatase inhibitor, gonadotropin-releasing hormone agonist), surgical excision remains a good option, frequently performed for symptoms palliation. Laparoscopic approach might be considered the procedure of choice in case of symptomatic women with leiomyomatosis peritonealis disseminata.

Did Your Evidence-Base Program Work? Share the News! CLUES #5/6: Assess and Alert.

The work of the school nurse does not end with the institution of an evidence-based intervention. The steps of EBP tell us that we must "Assess" the effectiveness of an intervention to determine if it is having the desired effect. When we find success in our EBP changes we must come full circle and share or "Alert" stakeholders and other school nurses by disseminating our work. School nurses can share their success through written and oral presentations to insure that we add to our collective school nursing knowledge.

A comparative study on posts released by WeChat official accounts of Wuhan′s tertiary hospitals / 中华医院管理杂志

Objective@#To comprehensively analyze the characteristics of posts released on WeChat official accounts of tertiary hospitals in Wuhan, and compare the two types of communication platforms varying in penetration power in terms of posts features and text contents. The aim is to identify post service strategies for enhancing influence of their WeChat accounts and to provide applied support for their operations regarding posts.@*Methods@#A total of 2 668 full-text messages were collected from the WeChat accounts of 22 tertiary hospitals in Wuhan in 2017. The 22 hospitals were categorized into a high WCI group and an ordinary group via Pareto′s principle. Then content analysis and data statistical analysis among others were used to analyze and compare the contents of the two groups in such five dimensions as push time, push content, title feature, media type and originality based on the WCI index.@*Results@#The push timing of WeChat articles focuses on the two time periods from 10: 00 to 12: 00 and from 16: 00 to 18: 00. These articles mostly aim at disseminating health knowledge (accounting for 37% of total articles) and describing hospital information (accounting for 29% of total articles). There were significant difference between the WeChat accounts of the two groups of hospitals in terms of title characteristics, media forms, and originality (P<0.01).@*Conclusions@#Hospitals can enhance their WeChat accounts′ penetration power and hospital influence by means of optimized push time, featured titles, enriched media forms, and customized articles.

Anti-MOG antibody-positive ADEM following infectious mononucleosis due to a primary EBV infection: a case report.

BACKGROUND: Anti-Myelin oligodendrocyte glycoprotein (MOG) antibodies are detected in various demyelinating diseases, such as pediatric acute disseminated encephalomyelitis (ADEM), recurrent optic neuritis, and aquaporin-4 antibody-seronegative neuromyelitis optica spectrum disorder. We present a patient who developed anti-MOG antibody-positive ADEM following infectious mononucleosis (IM) due to Epstein-Barr virus (EBV) infection. CASE PRESENTATION: A 36-year-old healthy man developed paresthesia of bilateral lower extremities and urinary retention 8 days after the onset of IM due to primary EBV infection. The MRI revealed the lesions in the cervical spinal cord, the conus medullaris, and the internal capsule. An examination of the cerebrospinal fluid revealed pleocytosis. Cell-based immunoassays revealed positivity for anti-MOG antibody with a titer of 1:1024 and negativity for anti-aquaporin-4 antibody. His symptoms quickly improved after steroid pulse therapy followed by oral betamethasone. Anti-MOG antibody titer at the 6-month follow-up was negative. CONCLUSIONS: This case suggests that primary EBV infection would trigger anti-MOG antibody-positive ADEM. Adult ADEM patients can be positive for anti-MOG antibody, the titers of which correlate well with the neurological symptoms.

Monitoring the coagulation status of trauma patients with viscoelastic devices.

Coagulopathy is a physiological response to massive bleeding that frequently occurs after severe trauma and is an independent predictive factor for mortality. Therefore, it is very important to grasp the coagulation status of patients with severe trauma quickly and accurately in order to establish the therapeutic strategy. Judging from the description in the European guidelines, the importance of viscoelastic devices in understanding the disease condition of patients with traumatic coagulopathy has been widely recognized in Europe. In the USA, the ACS TQIP Massive Transfusion in Trauma Guidelines proposed by the American College of Surgeons in 2013 presented the test results obtained by the viscoelastic devices, TEG® 5000 and ROTEM®, as the standard for transfusion or injection of blood plasma, cryoprecipitate, platelet concentrate, or anti-fibrinolytic agents in the treatment strategy for traumatic coagulopathy and hemorrhagic shock. However, some studies have reported limitations of these viscoelastic devices. A review in the Cochrane Library published in 2015 pointed out the presence of biases in the abovementioned reports in trauma patients and the absence of a quality study in this field thus far. A quality study on the relationship between traumatic coagulopathy and viscoelastic devices is needed.

Leiomyomatosis peritonealis disseminata: case report and review of the literature.

Leiomyomatosis peritonealis disseminata (LPD) is typically a benign and rare disorder found in female patients, prior to menopause. It can be found in the subperitoneal or peritoneal spaces and is represented by multiple different sized myomatous nodules (smooth muscle tumors). Additionally, it has also been found in women after menopause as well as in men. Despite the fact that high levels of estrogen and progesterone play a significant role in this disorder, the mechanism behind LPD development and a definitive therapeutic concept has yet to be conceived. This disorder is mostly found incidentally during imaging or surgery as it is often an asymptomatic condition. The present case reports an incident of LPD, clinically similar to peritoneal metastases, in a patient with a past history of dermatofibrosarcoma of Darier and Ferrand.

Deficiencia congénita de proteína C en un recién nacido con trombosis y necrosis de tejidos extensa / Congenital C protein deficiency in a newborn with extensive thrombosis and necrosis of tissues

Uno de los trastornos hematológicos más graves del período neonatal es la deficiencia congénita de proteína C, de presentación muy rara, y causa de enfermedad tromboembólica severa y púrpura fulminante en recién nacidos. Se puede sintetizar como una entidad clínico-patológica, de aparición aguda, con trombosis de la vasculatura de la dermis, lo cual conduce a necrosis hemorrágica y progresiva de la piel, asociada a coagulación intravascular diseminada y hemorragia perivascular, que ocurre en el período neonatal. El paciente presentado exhibe los elementos clínico-patológicos que caracterizan la púrpura fulminante, cuyo origen se debe a una deficiencia hereditaria de proteína C, lo cual condujo a la aparición de complicaciones trombóticas severas(AU)

One of the most serious hematological disorders of the neonatal period is congenital C protein deficiency of very rare occurrence and the main cause of severe thromboembolic disease and purpura fulminans in newborns. It may be summarized as a clinical and pathological entity of acute occurrence, with dermis vasculature thrombosis that leads to progressive hemorrhagic necrosis of the skin, associated to disseminate intravascular coagulation and perivascular hemorrhage in the neonatal period. The patient of this report showed the clinical and pathological elements characterizing purpura fulminans the origin of which is due to hereditary C protein deficiency that led to onset of severe thrombotic complications in this patient(AU)

Deficiencia congénita de proteína C en un recién nacido con trombosis y necrosis de tejidos extensa / Congenital C protein deficiency in a newborn with extensive thrombosis and necrosis of tissues

Uno de los trastornos hematológicos más graves del período neonatal es la deficiencia congénita de proteína C, de presentación muy rara, y causa de enfermedad tromboembólica severa y púrpura fulminante en recién nacidos. Se puede sintetizar como una entidad clínico-patológica, de aparición aguda, con trombosis de la vasculatura de la dermis, lo cual conduce a necrosis hemorrágica y progresiva de la piel, asociada a coagulación intravascular diseminada y hemorragia perivascular, que ocurre en el período neonatal. El paciente presentado exhibe los elementos clínico-patológicos que caracterizan la púrpura fulminante, cuyo origen se debe a una deficiencia hereditaria de proteína C, lo cual condujo a la aparición de complicaciones trombóticas severas(AU)

One of the most serious hematological disorders of the neonatal period is congenital C protein deficiency of very rare occurrence and the main cause of severe thromboembolic disease and purpura fulminans in newborns. It may be summarized as a clinical and pathological entity of acute occurrence, with dermis vasculature thrombosis that leads to progressive hemorrhagic necrosis of the skin, associated to disseminate intravascular coagulation and perivascular hemorrhage in the neonatal period. The patient of this report showed the clinical and pathological elements characterizing purpura fulminans the origin of which is due to hereditary C protein deficiency that led to onset of severe thrombotic complications in this patient(AU)

Disseminated gouty panniculitis: an unusual presentation of extensive cutaneous tophi.

Gouty panniculitis is a rare cutaneous illness characterized by the deposition of subcutaneous mono-sodium urate crystals with lobular panniculitis. Only a small number of cases with gouty panniculitis have been reported in the literature with unclear pathogenesis. In this article, we present a case of disseminated gouty panniculitis in the patient who had never been diagnosed of gout but revealed significant hyperuricemia at the time of diagnosis.

Disseminated Staphylococcus aureus infection in children:a clinical analysis of 14 cases / 临床儿科杂志

Objective To study the disseminated Staphylococcus aureus infection (DSAI) in children. Method Clinical features, treatment and prognosis data of 14 children with DSAI admitted to Yuying Children’s Hospital Afifliated to Wenzhou Medical University from January 2006 to December 2013 was retrospectively reviewed. Results 14 children with DSAI occurred in community, median age:15m (range 6d–13y);50%male (7 cases). All patients presented with fever. Addition to fever, the ifrst symptom was skin and soft tissue infections (SSTIs,6 cases) as well as limb and/or joint pain (5 cases). Among children with DSAI, white blood cell count and C-reactive protein values increased signiifcantly. Pyogenic infection site were skin and soft tissue in 12 cases (85.7%), pulmonary (12 cases), bone (4 cases), joint (3 cases), central nervous system (3 case), and pericardium (1 case). SSTIs concurrent with pulmonary infection was found in 10 cases (71.4%). Incision and drainage of skin and soft tissue abscesses were performed in 9 cases, joint debridement and vacuum sealing drainage (VSD) in 3 cases, osteomyelitis debridement and VSD in 3 cases, and closed chest drainage in 3 cases. All cases received vancomycin and/or linezolid treatment, 5 cases supplemented by rifampicin, and intravenous immune globulin therapy was administered in 11 cases. Clinical manifestations were cured or improved in 12 cases (85.7%). Conclusions Clinical diagnosis of DSAI in children needs to be vigilant. SSTIs, bone and joint infections were major precipitating factors. Intravenous immune globulin therapy was supplemented to the application of antibiotics, which might get better clinical outcomes in children.