Late onset group B streptococcal disease manifests as submandibular cellulitis

A 3033g male infant was born to a healthy mother at 39 weeks gestation by normal vaginal delivery with Grade 1 meconium stained liquor. There was no prolonged rupture of membranes or any antenatal risk factors for sepsis. The immediate neonatal period was uneventful and the baby was discharged after two days. At 6 weeks of age the baby was admitted with an 8-hour history of inconsolable crying. He was pyrexial. Initially the possibility of intussuception was considered, however, the submandibular swelling became more obvious and tender. His airway was clear. Chest x-ray and abdominal x-ray were normal. Ultrasound of the submandibular region showed soft tissue swelling with no fluid collection. CRP was initially 0.7 but increased to 87 the next day. Blood cultures grew group B streptococcus. (GBS) He was treated for five days with appropriate intravenous antibiotics. He was discharged home and recovered fully.

Facial plexiform neurofibroma in a child with neurofibromatosis type I: a case report

Plexiform neurofibroma is a non-circumscribed, thick and irregular benign tumor of the peripheral nerve sheath. It is a virtually pathognomonic and often disabling feature of neurofibromatosis type I. The diffuse and soft nature of plexiform neurofibroma is often compared to 'a bag of worms' and is difficult to distinguish from a vascular malformation or a lymphangioma, thus necessitating thorough clinical and histopathological examination and imaging of the lesion. We present a case of plexiform neurofibroma in a 12-year-old male child.

Johanson--blizzard syndrome

Johanson-Blizzard syndrome is an extremely rare ectodermal dysplastic disorder characterized by aplasia or hypoplasia of alae nasi, midline scalp defects, growth retardation, varying degrees of mental retardation, hypothyroidism, exocrine pancreatic insufficiency and congenital deafness. This condition is supposed to be an autosomal recessive disorder. We are reporting a female neonate with the characteristic features and an uncommon less emphasized feature viz. cafe-au-lait spots.

Cost-effectiveness of percutaneous radiofrequency ablation for malignant hepatic neoplasms

PURPOSE

Percutaneous radiofrequency (RF) ablation is a promising technique for the treatment of hepatic malignancies. However, its cost-effectiveness has not been established. The purpose of this study is to determine the cost-effectiveness of RF ablation compared to palliative care in the treatment of hepatocellular cancer and colorectal liver metastases. This study also seeks to evaluate the effects of transition from traditional to newly implemented prospective outpatient reimbursement mechanisms on RF ablation cost-effectiveness.

MATERIALS AND METHODS

The marginal direct costs of a percutaneous RF ablation treatment strategy were compared to palliative care over a range of survival benefits with use of a cost-effectiveness model built from the perspective of the payer. Variables used in the model, including complication rates and procedure efficacy, were obtained from the literature and the authors' experience with 46 consecutive patients.

RESULTS

The cost-effectiveness of a standardized percutaneous RF ablation treatment strategy compared to palliative care was $20,424, $11,407, $5,034, and $3,492, respectively, per life-year (LY) gained when marginal median survival conferred by RF ablation is 6 months, 1 year, 3 years, and 5 years. The RF ablation treatment strategy would be required to generate 6.14, 2.26, and 1.10 months of marginal median survival benefit to achieve strict ($20,000/LY gained), moderate ($50,000/LY gained), and generous ($100,000/LY gained) cost-effectiveness thresholds. Cost-effectiveness was sensitive to the number of lifetime treatments, hours of observation time, frequency of follow-up evaluations, cost of abdominal computed tomography, and decision to perform RF ablation as an inpatient or outpatient.

CONCLUSION

Percutaneous RF ablation is a cost-effective treatment strategy compared to palliative care and has likely already achieved the survival benefit required to meet even a strict cost-effectiveness criterion. Dependence on reimbursement mechanism highlights the importance of concordance between policy and RF ablation technology. The results of this study allow flexible application of cost-effectiveness data despite current uncertainties in treatment and survival data and heterogeneity in treatment populations.

Limb kinking in supported and unsupported abdominal aortic stent-grafts

PURPOSE

The occurrence of kinking of stent-graft limbs depends on the patient's anatomy and the device used. The purpose of this investigation was to determine the rates of limb kinking in supported and unsupported aortic stent-grafts.

MATERIALS AND METHODS

The authors performed a retrospective review of patients undergoing placement of either a Guidant Ancure/EGS or Medtronic Talent aortic stent-graft for the treatment of abdominal aortic aneurysm as part of separate phase II and phase III clinical trials. The records of 91 consecutive patients with 149 limbs were reviewed. The type and configuration of each device and any procedure performed specifically relating to limb patency was recorded. An analysis was then performed comparing the rates of kinking in supported and unsupported groups. A review of the literature was also performed.

RESULTS

Overall, there was kinking in 18 of 149 limbs (12%). In the supported stent-graft group, 48 bifurcated and 26 aortomonoiliac grafts were placed, with a total of 122 limbs at risk. Six limbs (5%) in five patients required intervention as a result of limb kinking. Stents were placed intraoperatively in two limbs (2%) and postoperatively in four limbs (3%) for thrombosis or severe stenosis. In the unsupported group, 12 bifurcated and three aortomonoiliac grafts were placed, with a total of 27 limbs at risk. Twelve limbs (44%) in eight patients required some type of intervention as a result of limb kinking. Stents were placed intraoperatively in seven limbs (26%) and postoperatively in five limbs (19%) for thrombosis or severe stenosis. Rates of limb kinking were significantly different between the supported and unsupported groups (P < .0001).

CONCLUSIONS

The use of supported versus unsupported stent-grafts impacts the occurrence of limb kinking. A direct comparison of the groups suggests that an unsupported stent-graft will be more than 15 times more likely than a supported system to require intervention because of kinking.

Elevated alpha-fetoprotein secondary to Hodgkin's lymphoma

We describe the case of a 26-year-old man with an elevated level of alpha-fetoprotein who had no evidence of intragonadal or extragonadal germ cell tumor. The patient was found to have Hodgkin's lymphoma within an anterior mediastinal mass. We review the significance of elevated alpha-fetoprotein levels and discuss the clinical relevance of this unusual presentation of a possible primary Hodgkin's lymphoma.

Bilateral primary non-Hodgkin's lymphoma of the testis

We report the case of a 72-year-old man with bilateral testicular masses that, on histologic section, were found to be synchronous non-Hodgkin's lymphomas. Workup was negative for systemic disease, indicating the possibility of bilateral primary testicular lymphomas. We discuss the evaluation and treatment of this lesion and review the literature concerning this subject.