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Cefdinir is one of the broad spectrum cephalosporin used as a replacement to amoxicillin in allergic pediatric population. There are reports of forming red stool in patients receiving cefdinir along with iron or iron containing preparations. This is a benign interaction and wane upon completion/discontinuation of cefdinir therapy. This case report describes a 6-month-old boy whose parents were distressed when they found reddening of their ward's diaper while taking cefdinir in presence of iron supplements.

Small intestinal transplantation is performed for patients with intestinal failure who failed other surgical and medical treatment. It carries notable risks, including, but not limited to, acute and chronic cellular rejection and graft malfunction. Late severe acute intestinal allograft rejection is associated with increased risk of morbidity and mortality and, in the majority of cases, ends with total enterectomy. It usually results from subtherapeutic immunosuppression or nonadherence to medical treatment. We present the case of a 20-year-old patient who underwent isolated small bowel transplant for total intestinal Hirschsprung disease at age 7. Due to medication nonadherence, she developed severe late-onset acute cellular rejection manifested by high, bloody ostomy output and weight loss. Ileoscopy showed complete loss of normal intestinal anatomic landmarks and ulcerated mucosa. Graft biopsies showed ulceration and granulation tissue with severe architectural distortion consistent with severe intestinal graft rejection. She initially received intravenous corticosteroids and increased tacrolimus dose without significant improvement. Her immunosuppression was escalated to include infliximab and finally antithymocyte globulin. Graft enterectomy was considered repeatedly; however, clinical improvement was noted eventually with evidence of histologic improvement and salvage of the graft. The aggressive antirejection treatment was complicated by development of post-transplant lymphoproliferative disorder that resolved with reducing immunosuppression. Her graft function is currently maintained on tacrolimus, oral prednisone, and a periodic infliximab infusion. We conclude that a prompt and aggressive immunosuppressive approach significantly increases the chance of rescuing small bowel transplant rejection.

application/pdf, 本稿では，英語の罵倒語の中で，強意語的機能を持つdamn, fucking, bloodyを取りあげる。まず，高増（2000），Hughes（2006），McEnery（2006），Ljung（2011）などを含む既存研究を前提に，これらの共通の特徴をまとめた後，OED3（Online）の初例を基に，これらの罵倒語の通時的な発達順序を辿ることにする。その結果，bloody ⇒ damn ⇒ fucking の順序で，ほぼ100年間隔で強意語的機能が発達していることを確認する。そして，取り上げた3種類の罵倒語の共通の機能的進化として，adj.（ pre-noun: attributive） ⇒ adj.（ pre-noun: intensifier）⇒ adv.（ pre-adjective: intensifier） ⇒ adv.（ pre-verb:intensifier），という機能転換（functional shift）の1つである品詞転換（conversion）が起きていることを明らかにする。また同時に，これらの罵倒語が修飾する共起構造として，どのような構造があるのかについて考察する。 後半では，新井（2011）に倣って，「快性」素性［±PLEASANT］（略して［±P］）を導入し，罵倒語が快素性［＋P］を持つ語との共起が，かなり進んでいることを明らかにする。そして，約30年の間隔があるBNC とNOW corpus（https://corpus.byu.edu/now/）の2つの大規模コーパスから，罵倒語の共起語の頻度の高いものを抽出し，特に快素性［＋P］を持つ共起語の広がり度を調査してまとめ，最近は特に，「damn と共起する［＋P］形容詞の種類と動詞との共起の種類が格段に増えていること」を明らかにする。

Objective: Cell blocks (CBs) are used to complement cytological diagnosis and for ancillary testing. Dissatisfaction with the cellular yield of the CB is widely recognized. Various techniques have been developed to increase the diagnostic utility of CBs. Study Design: We invented a new CB technique to increase cellular yield and diagnostic accuracy suitable especially for mucous and/or bloody cytological samples. Results: The new CB technique is described in detail with illustrations and cases, where it increased the cellular yield and diagnostic accuracy. CBs prepared by this method are suitable also for ancillary techniques, namely immunocytochemistry. Conclusions: The newly described method showed a better cellular yield in mucous and/or bloody cytological specimens.

Evidence suggests that gut microbiota dysbiosis plays a critical role in the initiation and promotion of inflammatory bowel disease (IBD). Kefir is a fermented dairy product including yeast and bacterial species. We aimed to investigate the effect of kefir on trinitrobenzene sulfonic acid (TNBS)-induced colitis in rats using two different doses. Fifty-four Wistar rats were divided into six groups. For 14 days, the normal control and colitis control groups were given tap water, kefir10 control, kefir10 colitis, and kefir30 control, and the kefir30 colitis groups were given phosphate-buffered saline containing 10% or 30% kefir, respectively, instead of tap water. Colitis was induced by intracolonically administrating TNBS in the colitis control, kefir10 colitis, and kefir30 colitis groups. On the 14th day, the rats were sacrificed. The weights and lengths of the colons were measured and macroscopically evaluated, and the distal 10 cm segments were subjected to a histopathological examination. The incidence of bloody stool and diarrhea in the kefir10 colitis group was found to be less than the colitis control and kefir30 colitis groups. The colonic weight/length ratio in the kefir10 colitis group was lower than that in the colitis control and kefir30 colitis groups. We detected that the 10% kefir treatment reduced TNBS-induced macroscopic colonic damage, while it was exacerbated by the 30% kefir treatment. No significant difference was observed between the colitis groups in terms of microscopic colonic damage scoring. These results indicate that kefir, with a careful dose selection, may be a useful agent in the treatment of IBD., Süleyman Demirel University Research Projects Management Unit

Background Solitary rectal ulcer syndrome (SRUS) is a rare rectal disorder characterized by bloody mucus in the stool, difficulty in defecation, pain, and anal swelling. To date, the etiology of this syndrome remains not well understood and the diagnosis is frequently confused with other disorders, making treatment a clinical challenge. Case summary A 50-year-old woman presented to our hospital with a 40-d history of bloody mucus in the stool and anal swelling. SRUS was suspected. Rectoscopy revealed a large, severe ulcerous lesion. Histologically, the lesion was characterized as chronic ulcer without clear tumor cells, and the final diagnosis of SRUS was made. The patient was treated with Chinese medicine therapy, with administration of Tong Xie Yao Fang. After 3 wk of treatment, the symptoms improved significantly. At 2-mo follow-up, rectoscopy in a local hospital showed healed ulcer scars without obvious protrusion 3 cm from the anal verge. Conclusion Chinese medicine therapy represents a potential treatment of SRUS with predominant rectal bleeding, mucinous discharge, and anal swelling pain.

It has not proved particularly easy to trace what is usually thought of as ‘folk song’ in England back into the eighteenth century. It is, however, possible in some instances to identify ve...

Introduction One of the most common inflammatory mass lesions of the nose are nasal polyps, which affect up to 4% of the population. Endoscopic surgery under local anesthesia may allow for a day-care surgical procedure for the patient; however, extensive procedures, revision surgeries, and uncooperative, and pediatric age group patients will warrant the use of general anesthesia. The aim of this study is to compare the efficacy of local versus general anesthesia for endoscopic surgical treatment of sinonasal polyposis during operation as well as during early and late postoperative periods together with patient’s acceptance for surgery. Patients and methods A total of 60 patients with sinonasal polyposis were divided randomly into two groups. Group 1 underwent endoscopic nasal surgery under local anesthesia and group 2 underwent endoscopic nasal surgery under general anesthesia. Results Most of the patients who were operated under local anesthesia showed good acceptance for surgery, short time of surgery, and less bloody field than those who were operated under general anesthesia (the P value was significant regarding bleeding and time during surgery under local anesthesia). Conclusion Surgery of sinonasal polyposis under local anesthesia is an effective method for the treatment of nasal polyposis as regards patient acceptance for the surgery, time of surgery with very good surgical field, and less cost procedures.

Ulcerative colitis is a chronic inflammatory disease affecting mainly the colon and presenting with diarrhea, bloody defecation andabdominal pain. Although cardiac and/or pulmonary involvement has been reported in patients with ulcerative colitis, it rarelyinvolves both the pleura and pericardium at the same time. Also, it is difficult to determine whether pulmonary or cardiac diseaseis secondary to the ulcerative colitis drugs or to the underlying disease process. Here we present a rare case of pleuropericardialeffusion in a patient newly diagnosed with ulcerative colitis. In ulcerative colitis, the simultaneous involvement of the respiratoryand cardiovascular systems is uncommon yet potentially dangerous.

Hypertensive emergency, which occurs even in young adults, induces systemic organ damage and results in a poor prognosis. We herein report the case of a 27-year-old man who developed alveolar hemorrhaging with hypertensive emergency. He presented with bloody sputum, renal failure, and extremely high blood pressure (200/128 mmHg). Chest computed tomography revealed diffuse bilateral alveolar infiltrates suggestive of diffuse alveolar hemorrhaging. After intensive therapy with anti-hypertensive drugs, the alveolar hemorrhaging disappeared. Renal impairment was partially reversed. Therefore, we conclude that hypertensive emergency should be considered as a possible cause of hemoptysis, even in young adults.

Background Postoperative pain remains a major challenge following immediate breast reconstruction with 40% of patients experiencing acute pain and up to 60% developing chronic pain. Paravertebral blocks (PVB's) have emerged as a promising adjunct to standard analgesic protocols. The aim of this study was to assess the utility of PVB's in immediate breast reconstruction following mastectomy. Methods A retrospective review of patients undergoing immediate breast reconstruction following mastectomy was performed. The primary outcome was postoperative pain measured by total oral morphine equivalent usage and self reported pain scores and secondary outcomes were length of stay in the PACU, complications, and OR delay. Results Of 298 patients undergoing immediate breast reconstruction, 112(38%) underwent standard analgesic protocols and 186(62%) underwent PVB in addition to the standard protocol. PVB's were associated with reductions in average postoperative pain scores (2.8 vs 3.3, P = 0.002), total opiate consumption (52 units vs 63 units, P = 0.038) and time spent in the PACU 92 vs 142 minutes, P = 0.0228) compared to patients who had general anesthesia alone. The overall complication rate was 3.7% (7/186 patients), all which were minor complications such as headache, bloody tap, vasovagal episode and temporary weakness. The use of PVBs delayed the OR start time on average by 15 minutes (34 vs 49 minutes). Conclusions The present study offers one of the largest retrospective cohort studies to date evaluating the utility of PVB's in immediate breast reconstruction following mastectomy. We demonstrate that, PVB's in immediate breast reconstruction are associated with reductions in postoperative pain, narcotic usage and length of stay in PACU, but are associated with delays to the start time of the case. Anesthesiologists, plastic surgeons and hospital administrators must continue to work together to ensure this important and necessary service is administered in an efficient and cost effective manner.

Patient: Female, 58 Final Diagnosis: Epidermal inclusion cyst Symptoms: Bloody nipple discharge Medication: — Clinical Procedure: — Specialty: Radiology Objective: Rare disease Background: Epidermal inclusion cysts rarely develop in the breast. The cysts that do develop within the breast typically present as cutaneous or subcutaneous cysts. They more rarely present in a subareolar location or in a ruptured state. Thus far, 5 cases of ruptured epidermal inclusion cysts in subareolar locations have been reported in the English literature. Furthermore, clinical presentation of nipple discharge is rare in epidermal inclusion cysts of the breast; only 4 such cases has been reported. Case Report: A 58-year-old female presented with a 1-month history of bloody discharge from her left nipple. Mammography showed focal asymmetry in the left subareolar region; sonography showed a left subareolar mass with irregular shape, indistinct margin, heterogeneous echogenicity, and posterior enhancement. The mass was surgically excised; a pathological diagnosis of ruptured epidermal inclusion cyst with foreign body reaction and abscess formation was established. In this case, the clinical presentation of bloody nipple discharge was peculiar; furthermore, mammographic and sonographic features were indistinguishable from breast malignancy or typical breast abscess. Conclusions: A ruptured epidermal inclusion cyst can present in an unusual subareolar location, combined with bloody nipple discharge; importantly, this can radiologically resemble breast malignancy.

The patient was diagnosed with ulcerative colitis and received remission induction therapy with prednisolone. While they developed muscle pain in the lower extremities after starting prednisolone, they ultimately achieved clinical remission. After discharge, hematemesis and gastric discomfort developed. Esophagogastroduodenoscopy showed mucosal edema, redness, and oozing bleeding in the gastric body. In addition, the patient had bloody stool and was considered to have a relapse of ulcerative colitis. They therefore received remission induction therapy with tacrolimus. The patient achieved clinical remission again; however, gastric discomfort and muscle pain remained. A drug lymphocyte stimulation test revealed positivity for prednisolone; therefore, the patient was diagnosed with an allergy to prednisolone.

First, I begin by interrogating why blood as kinship, ethnicity, nationality, identity, etc., has been so clinically removed from so much Humanities-oriented poststructuralist and postcolonial diaspora theory, rendering it both bloodless and hostile towards the notion of a return to an ethnic homeland. Second, I analyze policies based on the “migration-development nexus” promoted by organizations like the World Bank with its reliance on a conception of bloody roots and an enduring ethnic homeland that is both essentialist and static. To point out the limitations of these theories, I examine some recent frontier heritage migrations in which Asian and African diasporic elites raised in Euro-America are “returning” to their ethnic homelands. Finally, I attempt to lay out some of the parameters of a more fluid, supple theory of diaspora for the twenty-first century that explores blood as an analytic tool that takes into account not only mobile yet bloody identities but also mutable places, dynamic economic change, and new forms of spatiotemporality. In other words, returning to the homeland is not what it used to be, hence new constructions of blood identification are now possible.

Purpose Gastrointestinal stromal tumors (GISTs) are typically solid neoplasms with small cystic change detected occasionally but in rare instances may present predominantly as cystic lesions. The histopathologic features and prognoses of cystic GISTs (cGISTs) are poorly understood. Methods We herein reviewed 20 cGISTs resected or consulted in our institution from January 1, 2003 to December 31, 2014. Results Of the 20 patients included, the mean age was 61 years and the male-to-female ratio was 9:11. The original locations were the stomach (n = 10, 50%), the small intestine (n = 9, 45%) and the omentum (n = 1, 5%). Indistinct diagnosis or misdiagnosis was established in 15 cases based only on preoperative radiology. Grossly, the cystic component made up the bulk of masses and was filled by dark bloody fluid and necrotic debris in 18 cases. Microscopically, cyst wall was composed of neoplastic spindle (n = 14, 70%)/epithelioid cells (n = 6, 30%) and collagenous fiber, with necrotic debris and granulation tissue lining on the inner surface. cGISTs resembled their solid counterparts in terms of morphology and immunohistology but demonstrated fewer malignant parameters. c-kit or PDGFRα mutations were detected in eleven cases with the remaining being wild type for these two mutations. Although classified as intermediate or high (3 and 17, respectively) risk of recurrence according to modified National Institute of Health criterion, most patients with cGISTs experienced long-term recurrence-free survival without adjuvant imatinib. Conclusions Cystic GISTs is a relatively indolent subset of GISTs with favorable prognoses and adjuvant imatinib should be a prudent consideration.

Aim. The study aimed at investigating the relationship between severe exacerbations of chronic obstructive pulmonary disease and hemorrhagic component of endobronchial inflammation. Materials and methods. Clinico-endoscopic characteristics of 118 patients presenting with severe infectious exacerbation of chronic obstructive pulmonary disease, bloody expectorations and endoscopically confirmed hemorrhagic component of endobronchial inflammation have been analyzed. All patients underwent a series (5-6) of bronchoscopic examinations accompanied by collection of bronchoalveolar lavage specimens to reveal the presence of acid-resistant mycobacteria and to determine the bacterial flora. The exclusion criteria were the concomitant pulmonary or extrapulmonary pathologic conditions which could lead to hemorrhagic endobronchial manifestations. The other direction of the study was to investigate a correlation between jugulation of the exacerbation and dynamics of such endobronchial symptoms as mucosal edema and hyperemia, quality of bronchial secretions and hemorrhagic component of endobronchial inflammation. Results. All patients were found to have diffuse endobronchitis of severity grade II (39.83%) or III (60.17%) by Lemoine. The neoplastic and tuberculosis genesis of the hemorrhagic component of endobronchial inflammation and its clinical equivalent, the bloody expectorations, had been ruled out. In 50.85% of cases the hemorrhagic component of endobronchial inflammation could not be accounted for by hemolytic properties of cultured microorganisms. The mucosal edema and hyperemia remained stable during jugulation of the exacerbation. Unlike the improvement of quality of bronchial secretions, faster reversal of the hemorrhagic component of endobronchial inflammation showed statistical significance. Conclusion. The hemorrhagic component of endobronchial inflammation can represent a non-obligatory manifestation of severe exacerbation of chronic obstructive pulmonary disease, and its relief is the earliest endobronchial sign of incipient remission from severe COPD exacerbation.

Background/Aims: Selecting patients with an urgent need for endoscopic he mostasis is difficult based only on simple parameters of presumed acute upper gastrointestinal bleeding. This study assessed easily applicable factors to predict cases in need of urgent endoscopic hemostasis due to acute upper gastrointestinal bleeding. Methods: The consecutively included patients were divided into the endoscopic hemostasis and nonendoscopic hemostasis groups. We reviewed the enrolled pa tients’ medical records and analyzed various variables and parameters for acute upper gastrointestinal bleeding outcomes such as demographic factors, comor bidities, symptoms, signs, laboratory findings, rebleeding rate, and mortality to evaluate simple predictive factors for endoscopic treatment. Results: A total of 613 patients were analyzed, including 329 patients in the endo scopic hemostasis and 284 patients in the non-endoscopic hemostasis groups. In the multivariate analysis, a bloody nasogastric lavage (adjusted odds ratio [AOR], 6.786; 95% confidence interval [CI], 3.990 to 11.543; p < 0.0001) and a hemoglobin level less than 8.6 g/dL (AOR, 1.768; 95% CI, 1.028 to 3.039; p = 0.039) were indepen dent predictors for endoscopic hemostasis. Significant differences in the morbid ity rates of endoscopic hemostasis were detected between the group with no pre dictive factors and the group with one or more predictive factors (OR, 2.677; 95% CI, 1.920 to 3.733; p < 0.0001). Conclusions: A bloody nasogastric lavage and hemoglobin < 8.6 g/dL were inde pendent predictors of endoscopic hemostasis in patients with acute upper gastro intestinal bleeding.

A case study of a 37 weeks' gestational age male infant, presenting with bloody fluid orally shortly after birth. The presentation, etiology, diagnosis, and management of pulmonary hemorrhage are addressed.

Objective To study the association between bloody amniotic fluid (BAF) during labor and adverse pregnancy outcomes. Study design In the last 10 years we have implemented an institutional protocol that mandates obstetricians/midwives to report their subjective impression of the color of amniotic fluid (clear, meconium stained, bloody) during labor. The medical records, and neonatal charts of all singleton deliveries ≥ 370/7 weeks between 2008–2018 were reviewed. The cohort was divided into two groups: clear AF (Clear group) and BAF (BAF group). Cases with meconium stained AF were excluded. The primary outcome was a composite of the following complications: umbilical Ph ≤ 7.1, seizures, hypoxic-ischemic encephalopathy, intra-ventricular hemorrhage, periventricular leukomalacia, hypoglycemia, hypothermia, mechanical ventilation, meconium aspiration syndrome, RDS, NEC, phototherapy, sepsis, or transfusion. Results Overall, 21,300 deliveries were reviewed, 20,983 (98.5%) in the Clear group and 317 (1.5%) in the BAF group. The rate of the primary outcome did not differ between the BAF (2.2%) and the Clear (2.1%) groups. The rate of placental abruption (both clinically and hystopathologically) did not differ between the groups (3.2% vs. 1.9% and 1.6% vs. 0.6%, respectively). BAF was associated with higher rates of labor induction (p = 0.002), assisted vaginal deliveries (p = 0.04), cesarean deliveries (p = 0.03), and lower birth weights (p = 0.03). Conclusion BAF observed in labor was not associated with composite adverse neonatal outcome, nor with placental abruption. BAF was associated with higher rates of labor induction, assisted vaginal deliveries, cesarean deliveries, and lower birth weights. These findings may assist obstetricians and neonatologists in the interpretation of BAF observed in labor.

Two experimental studies in Poland examined how perceived and manipulated realism of comedic violence may influence consumer responses to brands. Disposition to laughter, measured by katagelasticism (the joy of laughing at others), gelotophilia (the joy of being laughed at), and gelotophobia (the fear of being laughed at), was included as a potentially important factor in driving individual responsiveness to humorous messages. The results reveal that highly violent humor—compared with less violent humor—lowered perceptions of realism and produced negative brand attitudes. Manipulated realism led to less positive attitudes than manipulated unrealism in a high comedic violence condition but had no effect on brand evaluations when comedic violence was low. In both studies, the effects of realism on brand attitudes grew with increasing levels of katagelasticism and gelotophilia.

Antecedentes: La Invaginación Intestinal (II) es una alteración caracterizada por introducción de una porción de intestino en sí misma y en sentido distal. Está asociado a ciertas infecciones entéricas y de vía aérea superior, como adenovirus, enterovirus y rotavirus. Objetivo: caracterizar el perfil epidemiológico y clínico de la II en niños menores de 2 años. Pacientes y métodos: Estudio descriptivo, transversal se incluyeron niños menores de 2 años con sospecha clínica de II ingresados en el servicio de pediatría. Se obtuvo una muestra de 20 pacientes. Datos fueron obtenidos de expedientes clínicos, interrogatorio dirigido a padres o tutores y seguimiento hasta su egreso. Resultados: El 60% eran menores de 6 meses, relación hombre- mujer 1.5-1,35% presentó algún grado de desnutrición, 81% recibió dos dosis de vacuna rotavirus. El primer síntoma presentado fueron 40% vómitos, 25% diarrea, 15% heces con sangre y 5% distensión abdominal; la sintomatología previa a la cirugía fue: distensión abdominal (30%) dolor o llanto inconsolable (25%), paro de evacuaciones (15%), fiebre y diarrea (10%), vómitos y heces con sangre (5%). Al 70% se realizó tacto rectal, de estos 5% se palpo masa en recto y 25% presentó salida de heces con sangre. Al 100% se realizó laparotomía, la localización principal fue ileo-colica en el 50% de los casos. Conclusión: La presentación clínica de II en lactantes es atípica, lo que hace necesario realizar un examen físico exhaustivo para detectar signos clínicos característicos de la enfermedad. Palabras clave Intususcepción, Laparotomía, vómitos, vacunación

For thousands of incarcerated women in the United States, dealing with menstruation is a nightmare. Across the country, many female prisoners lack sufficient access to feminine hygiene products, which negatively affects their health and rehabilitation. Although the international standards for the care of female prisoners have been raised in attempt to eliminate this issue, these stan- dards are often not followed in the United States. This Comment argues that denial of feminine hygiene products to female prisoners violates human de- cency. Additionally, this Comment considers possible constitutional violations caused by this denial, reviews current efforts to correct this problem, and pro- vides suggestions for possible legislative solutions.

Four-toed hedgehogs presented bloody stool and loss of appetite. Integumental masses were observed in two of the four cases. Intraabdominal masses were observed on radiographs and ultrasonography in the remaining two cases. The masses were surgically removed from all four cases. All samples were histologically and immunohistochemically consistent with histiocytic sarcoma (HS). At the time of surgery, 3 of 4 cases had grossly recognized metastatic/disseminated lesions. Survival time was 48 days, 64 days, and 113 days, respectively, and the remaining case is currently alive (at Day 207). The present report describes the clinical management and outcome of hedgehogs that were diagnosed with HS.

In my paper, I want to explore the idea that the heroine in Angela Carter’s The Bloody Chamber is a “woman in process” (Kathleen E. B. Manley 1998, 71), focusing on three main aspects connected to this journey of self-discovery. One is the presence of the mother and the mother-daughter relationship. Another is sexuality and how the heroine’s attitude towards it changes over the course of the story. Finally, the third is the significance of gazing, proposing that by the end of the story, a female gaze emerges.

Background: Hematohidrosis, also known as hematidrosis or bloody sweat. It is a rare condition manifested by sweaty spotty bleeding out of the skin and mucous membranes . Apart from sporadic case reports from around the world there is a lack of formal study that describe the exact incidence. There is uncertainty of the etiopathogenesis. However rupture of the capillary ramification around the sweat glands due to severe physical or mental stress has been proposed as an explanation, in addition to some other disorders as systemic disease and vicarious menstruation. Diagnosis is being confirmed by testing the secretions for blood components. Case presentation: Herein, we report a case of hematohidrosis in a-28‑year‑old female with repeated episodes of bloody sweating from all over the face, the genitalia and the fingertips that has been responding to propranolol and topical timolol. Conclusion: Being a rare disorder, the diagnosis is substantially dependent on high clinical suspicion and physician awareness, which is of paramount importance in patient’s assurance that helps in alleviation of psychological stress. We assume that sympathetic overactivity is pivotal in provoking these events, and that beta blockers might be effective treatment.

The subtrochanteric fractures are relatively rare in the child and they constitute a therapeutic problem. The pseudarthrosis of this fracture in the child is often the complication of a subtrochanteric fracture treated orthopedically. We report the case of a subtrochanteric pseudarthrosis in a 5 year-old child occurred following an orthopedic treatment. After surgical treatment by bloody reduction and pinning, the pseudarthrosis consolidated in 10 months with satisfactory functional results.

Background: Tonsillectomy is one of the most frequently performed operations in otolaryngology, especially in children. Basically, bleeding within 24 h has been classified as primary bleeding whereas bleeding occurring from the next day after surgery has been classified as secondary bleeding. Aim of the Work: Was to review the possibility of decreasing the incidence of post- tonsillectomy hemorrhage along with the associated complications. Methods: This is a prospective study enrolling one thousand and two hundred patients undergoing tonsillectomy (with or without adenoidectomy in Al- Azhar University Hospitals (El-Hussien – Sayed Jalal - AL Zahraa) from April 2018 till December 2018. We restricted the study to full time participants and resident staff so that complete records would be available. Results: The mean age of patients was 13.53 years, 47.62% of patients were male while 52.38% of patients were female. Primary bleeding occurred in 16 cases while secondary bleeding occurred in 32 cases. There are significant differences among studied groups as regard to control methods of post-tonsillectomy bleeding which could be conservative or operative. Conclusion: We concluded that patients with post-tonsillectomy bleeding should return for clinical evaluation as they may need conservative management or possible operation interference either for ligation or cautery of bloody tonsil, that trigger a need for external carotid artery ligation.

We report a case of thoracic endometriosis syndrome (TES) presenting with a five-week history of progressive shortness of breath, cough, and wheezing. Investigations revealed a large, right-sided pleural effusion that was bloody on aspiration. A diagnosis of TES was one of the diagnoses entertained and eventually confirmed on finding evidence of pelvic endometriosis on laparotomy. The management of TES should include hormonal therapy, surgical management, or a combination of both.

Chrysosporium zonatum is a soil‐dwelling fungus that rarely causes pulmonary infections, and a small number of cases have been reported to date. A 74‐year‐old man, who had previously been treated for tuberculosis, presented with symptoms of low‐grade fever, anorexia, cough, and bloody sputum. Chest computed tomography (CT) showed a thick‐walled cavitary lesion in the right upper lobe, in which there was a suspected mycotic mass. Initially, the patient was suspected to have chronic aspergillosis due to positive serum anti‐Aspergillus antibodies. However, bronchoscopic culture revealed the growth of C. zonatum. Symptoms and imaging findings improved with administration of voriconazole for 18 months. Infection by C. zonatum is very rare and is difficult to differentiate from aspergillosis by clinical features. Clinicians should be aware of the possibility of coinfection with C. zonatum and Aspergillus sp. Voriconazole may be an effective treatment option., We present a case of pulmonary mycosis caused by Chrysosporium zonatum after the completion of treatment for pulmonary tuberculosis.

When bloody stools occur in a very-low-birth-weight infant in the neonatal intensive care unit (NICU), necrotizing enterocolitis (NEC) is a prime consideration, though food protein-induced enterocolitis syndrome (FPIES) can be causative and is difficult to distinguish from NEC. Food allergy is an adverse reaction following exposure to food due to an abnormal immunologic response to food, and cow's milk allergy (CMA) is the most likely form of food allergy in infants. The clinical features and proper management of patients with FPIES are important to differentiate FPIES from NEC. However, there are very few study reports of preterm infants presenting with food allergy-induced enterocolitis after NEC. Here, we report a case of a very-low-birth-weight infant born at 28 weeks of gestational age who developed recurrent episodes of bloody stools when he was fed cow's milk or given breast milk fortified with milk after NEC recovery on day of life (DOL) 29, 46, and 54. A male preterm infant born at 28 weeks of gestational age presented with bloody stools on DOL 7. He was diagnosed with early-onset NEC with abdominal tenderness, sluggish bowel sounds, increased C-reactive protein (CRP) level and pneumatosis intestinalis (PI). After recovery from NEC on DOL 20, the infant developed three recurrent episodes of bloody stools after being fed cow's milk or breast milk fortified with dairy milk. He was suspected of having recurrent episodes of NEC, but the infant was fairly healthy and did not present abdominal tenderness or abnormal bowel sounds on physical examination. Consecutive blood tests revealed normal CRP levels and increasing eosinophil levels. Abdominal radiograph revealed mild thickening of the small bowel, with no evidence of PI. The infant was finally diagnosed with FPIES in addition to NEC. After the infant received hydrolyzed formula, the bloody stool symptoms were finally resolved. Our case suggests that infants with recurrent episodes of bloody stools with increasing systemic eosinophils count should be considered for the diagnosis of FPIES with cow's milk formula. Rapid improvement and non-progression of systemic symptoms and signs after removing exposure to milk protein may differentiate FPIES from NEC.

Delayed rupture of an aneurysm following WEB embolization has not yet been reported. We present a case of a multiply ruptured anterior communicating artery aneurysm treated via WEB embolization. A post-treatment CT scan confirmed no evidence of rebleeding during treatment. Four hours after treatment, the patient developed an acute, significant increase in intracranial pressure with bloody ventriculostomy output, with CT scan demonstrating new parenchymal and intraventricular hemorrhage. The aneurysm was subsequently treated via microsurgical clipping that did not identify an “uncovered” bleb or rupture source.

BACKGROUND Central neuraxial modalities can occasionally be challenging to perform, particularly if the underlying anatomy is altered or obscured. OBJECTIVES To compare the efficacy, efficiency and the safety of preprocedural ultrasound to landmark palpation in the nonobstetric adult population. DESIGN Systematic review of randomised controlled trials with meta-analysis and trial sequential analysis. DATA SOURCES Systematic search of Central, CINAHL, Embase, Global Health, MEDLINE, Scopus and Web of Science to 13th February 2020. ELIGIBILITY CRITERIA Randomised controlled trials of nonobstetric adult patients having diagnostic and/or therapeutic neuraxial procedures using standard preprocedural ultrasound interpreted by the operator as the intervention and conventional landmark palpation as the comparator. KEY DEFINITIONS A skin puncture was defined as the insertion or reinsertion of the needle through the skin; needle redirection was the backward followed by the forward movement of the needle without its removal from the skin; first skin puncture referred to a single skin puncture with or without needle redirections; and first pass was a single skin puncture with no needle redirection. RESULTS In all, 18 randomised controlled trials with 1800 patients were included. The first pass success rate was not different between landmark and ultrasound methods [risk ratio 1.46; 95% confidence interval (CI), 0.99 to 2.16; P = 0.06, I2 = 76%; moderate quality of evidence] and the trial sequential analysis demonstrated the futility of further randomisation of patients in modifying this finding. Preprocedural ultrasound increased the total time taken (mean difference 110.8 s; 95% CI, 31.01 to 190.65; P = 0.006; I2 = 96%; moderate quality of evidence). Subgroup analyses revealed no influence of the predicted difficulty of the neuraxial procedure on outcomes. Compared with the landmark method, ultrasound increased the first skin puncture success rate (risk ratio 1.36; 95% CI, 1.18 to 1.57; P

BackgroundIntussusception occurs when a segment of the bowel (the intussusceptum) telescopes into an adjacent segment (the intussuscipiens). Adult intussusception occurs rarely and often requires surgical resection for its treatment. We describe the case of an adult patient with extremely rare cecorectal intussusception treated using a novel combined transabdominal and trans-anal approach, which has not yet been reported in the literature.Case presentationA 71-year-old woman was transferred to our hospital for the treatment of upper abdominal pain. Physical examination, laboratory tests, and imaging inspections showed strangulated bowel obstruction induced by intussusception associated with the intra-rectal mass. We performed an emergency operation and treated the intussusception using a combined transabdominal and trans-anal approach. The intraoperative findings revealed bloody ascites and a potentially malignant tumor that had moved toward the anal side from peritoneal reflection. The tumor served as the lead point in the cecum with mobile cecum. After reducing the intussusception using the combined procedure, we removed the ileocecal portion. The intraoperative and histopathological findings suggested that cecum cancer with mobile cecum had caused the cecorectal intussusception. The patient had an uneventful postoperative course, except for postoperative pulmonary pneumonia.ConclusionTo the best of our knowledge, this is the first reported case of adult cecorectal intussusception due to cecum cancer with mobile cecum successfully treated using the combined transabdominal and trans-anal approach. This combined procedure may be useful in treating the intussusception where the lead point is distal from the peritoneal reflection.

TOPIC: Diffuse Lung Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: A 56 year old Hispanic woman with a history of asthma presented with five days of progressive dyspnea and hemoptysis. CASE PRESENTATION: Two months prior, she was treated for COVID-19 complicated by intermittent hemoptysis. Subsequently, her hemoptysis gradually worsened resulting in dyspnea on exertion and hypoxia (SpO2 88%). At presentation, she was febrile (100.8 F), tachycardic (141 bpm), tachypneic (36 breaths/min) and hypoxic (SpO2 85%). Exam was notable for coarse breath sounds and crackles on auscultation. Labs were notable for hemoglobin 6.7 g/dL and a negative SARS-CoV-2 PCR test. Chest CT showed extensive ground-glass and reticular opacities (upper lungs) and a cluster of air cysts (left lower lobe). The imaging findings in conjunction with frank hemoptysis and acute hypoxemic respiratory failure were concerning for diffuse alveolar hemorrhage (DAH). Bronchoscopy showed bloody secretions throughout the airway. Serial lavage aliquots returned progressively bloodier washings confirming DAH. She received empiric antibiotics with subsequent unremarkable infectious workup. She also received pulse dose steroids and underwent an autoimmune workup notable for: positive ANA (1:40), positive p-ANCA (1:1280), and positive MPO IgG (106 AU/mL) concerning for ANCA-associated vasculitis (AAV). Hospital course was complicated by intermittent fevers, hemoptysis, and hypoxia - likely progression of DAH secondary to her vasculitis. She was started on intravenous steroids and cyclophosphamide with resolution of hemoptysis and hypoxia. Post discharge, her rheumatological workup was negative for anti-cardiolipin antibodies, phosphatidylserine autoantibodies, beta-2 glycoprotein I antibodies, and DRVVT screen. DISCUSSION: DAH is a life-threatening condition that commonly presents with fever, cough, and dyspnea while hemoptysis may be absent in a third of patients. Bronchoscopic evaluation reveals progressively bloodier aliquots during lavage as noted in our patient. Treatment warrants addressing the underlying etiology, which may be cessation of the inciting drug, treatment of infection, or glucocorticoids for vasculitides. SARS-CoV-2 infection can directly cause DAH by inciting pulmonary endothelialitis. In contrast, our patient had a positive autoimmune workup for AAV, which was thought to be the immediate cause of her DAH. Without prior systemic manifestations of AAV (rash, arthritis, renal disease), either the patient developed AAV triggered by SARS-CoV-2 infection, or she had asymptomatic AAV that manifested due to the infection. There are multiple reports of COVID-19 predisposing to the development of autoimmune diseases, such as GBS and vasculitides, by triggering chronic inflammation. CONCLUSIONS: We hypothesize that our patient likely developed DAH because the infection led to ANCA-associated vasculitis that manifested as DAH rather than directly damaging her pulmonary blood vessels. REFERENCE #1: Lara AR, Schwarz MI. Diffuse alveolar hemorrhage. Chest. 2010;137(5):1164-1171. doi:10.1378/chest.08-2084 DISCLOSURES: No relevant relationships by Daniel Bouland, source=Web Response No relevant relationships by Elizabeth Epstein, source=Web Response Public Stock holder relationship with Cormedix Please note: 01/2021 Added 04/27/2021 by Vineet Gupta, source=Web Response, value=Purchased stock from market Public Stock holder relationship with Athenix Please note: 02/2021 Added 04/27/2021 by Vineet Gupta, source=Web Response, value=Purchased stock from market Public Stock holder relationship with Kinishka Please note: 02/2021 Added 04/27/2021 by Vineet Gupta, source=Web Response, value=Purchased stock from market Public Stock holder relationship with Novavax Please note: 03/2021 Added 04/27/2021 by Vineet Gupta, source=Web Response, value=Purchased stock from market No relevant relationships by Tonya Lee, source=Web Response No relevant relationships by Priya Sharma, source=Web Response No relevant relationships by Edward Wang, source=Web Re ponse

Purpose:The purpose of this study was to evaluate whether clinical findings in children with ileocolic intussusception differ based on age and duration of symptoms and to assess the clinical characteristics of diagnosed and undiagnosed patients to determine which symptoms make diagnosis more difficult.Methods:We reviewed 536 medical records of Results:Following analysis of the three age groups, bloody stool, post-enema bloody stool, diarrhea, vomiting, poor oral intake, and lethargy were more frequent in children aged Conclusions:Clinical findings of ileocolic intussusception vary depending on the age and duration of symptoms. Younger children with paroxysmal pain, vomiting, bloody stool, poor oral intake, or lethargy should be suspected of having intussusception. In older children, non-specific abdominal pain without bloody stool may be a symptom of intussusception. Glycerin enema is helpful in diagnosing intussusception in children with no typical symptoms.

Background: Endometriosis-related pleural effusion (PE) is a relatively rare but treatable cause of bloody PE. The clinical characteristics and outcome of patients with endometriosis-related PE remain unknown.Objectives: We present a case of endometriosis-related PE diagnosed on pleural fluid cytology. A systematic review of all endometriosis-related PE cases in literature was conducted to elucidate the clinical characteristics, explore the diagnostic yield of pathological examinations, and to summarize the outcomes of therapeutic approaches in this disease.Methods: A case of endometriosis-related PE diagnosed in study hospital was reported. PubMed, Web of Science, and EMBASE were searched for publications pertaining to cases of endometriosis-related PE using predefined search terms. This case and those identified from PubMed, Web of Science, and EMBASE were analyzed.Results: A total of 67 patients were included. Catamential symptoms were presented in 30 (44.8%) patients. Dyspnea was presented in 50 patients (74.6%), followed by right chest/shoulder pain in 34 (50.7%) and cough in 18 (26.9%). 82.8% of the patients had concomitant pelvic endometriosis and 76.7% was infertile or nulliparous. The diagnostic yield of pleural fluid cytological examination, percutaneous pleural biopsy, and surgical biopsy was 9.0, 45.5, and 78.7%, respectively. The patients who received surgery-based therapy had a significantly longer time to relapse than those who received progestational agents or GnRH analogs alone (P = 0.025) or hysterectomy and bilateral salpingoophorectomy (HBSO) (P = 0.040).Conclusions: High clinical awareness of pleural endometriosis is essential in all female with hemorrhagic PE, especially in young females who have infertility and/or pelvic endometriosis. Plerual fluid cytology might be a simple minimally invasive and cost-effective modality in the diagnosis of endometriosis-related PE. Treatment is challenging due to high recurrence and the optimal management of endometriosis-related PE needs further evaluation. The combined approach by surgery and hormonal therapy may achieve the best relapse-free survival.

BACKGROUND Ultrasound assistance improves success rates and reduces adverse outcomes of lumbar punctures (LPs) among adult patients in the emergency room and the operating room, but has not been evaluated in pediatric patients with cancer. Our objectives were (1) to determine whether pediatric oncologists could perform ultrasound-assisted LPs following a structured teaching curriculum, and (2) to determine the feasibility of recruiting pediatric cancer patients to a clinical trial of this procedure. METHODS Three pediatric oncologists completed a curriculum composed of didactic teaching followed by hands-on workshops. Each learner was evaluated during 20 attempts at three ultrasound tasks using the cumulative sum method. The three pediatric oncologists then performed ultrasound assessments prior to routinely scheduled LPs. Feasibility was defined as ability to perform at least 30 ultrasound-assisted LPs within 6 months. Secondary outcomes were the proportion of successful, bloody, or traumatic LPs, time required, and perceived helpfulness of ultrasound. RESULTS All three pediatric oncologists achieved competence in the three tasks of ultrasound scanning within 20 evaluated attempts. We recruited 62 patients within 1 month, and 58 underwent an ultrasound-assisted LP. All LPs were successful. Two LPs (4%) had ≥500 red blood cells (RBCs)/μl, and nine (16%) had ≥10 RBCs/μl. Median time to conduct the scan was 1.9 minutes (range 0.8-4.0 minutes). In 37 (64%) of the LPs, ultrasound assistance was considered helpful or very helpful. CONCLUSIONS Pediatric oncologists readily achieved competence in ultrasound-assisted LPs, and ultrasound was commonly perceived as helpful. It is feasible to proceed to a randomized trial of this procedure in pediatric cancer.

Background Granulomatosis with polyangiitis (GPA) is a syndrome of refractory vasculitis in the upper respiratory tract, lungs, kidneys, and systemic small and medium-sized arteries; adults and children have similar courses. A pediatric GPA case with a preceding bloody pericardial effusion, which caused cardiac tamponade, and bloody stool has not been reported. Case presentation: A 14-year-old boy was referred for the evaluation of prolonged fever. He had chest pain and bloody stools, and diagnostic imaging showed a pericardial effusion. Immediately after admission, his systolic blood pressure decreased (85/70 mmHg), and pericardiocentesis was performed, with aspiration of approximately 500 mL of bloody pericardial fluid. Because pericardiocentesis increased the blood pressure (115/65 mmHg), the cause of the blood pressure decrease was diagnosed as cardiac tamponade. Because the pericardial fluid cytology was negative for malignant disease, as were chest MRI and gallium scintigraphy, colonoscopy was performed and showed multiple irregular-shaped aphthae from the right transverse colon to the cecum on the contralateral side of the mesenteric attachments, and a biopsy of the aphthous region showed necrotizing granulomatous inflammation. The patient also had an elevated serine proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA) level (141 IU/mL) on serological examination. Head MRI showed thickening of nasal and sinus mucosa and a cystic mass in the left sphenoid sinus. Therefore, GPA was diagnosed based on these findings, and treatment with oral prednisolone (PSL) and azathioprine was started. After the treatment, the bloody stool disappeared, and there was no recurrence of pericardial effusion even after completing PSL tapering, and the PR3-ANCA level was maintained in the normal range. Conclusions Although pericarditis is a common cardiac complication of GPA, there have been no previous reports of cardiac tamponade due to pericarditis. This is the first case of a pediatric patient with cardiac and gastrointestinal complications preceding the main symptoms, including upper and lower respiratory tract and renal symptoms, although cases of GPA with bloody stools are extremely rare. In conclusion, the sequencing of measuring ANCA levels appears important assuming the vasculitic syndrome as one of differential diseases causing persistent fever and bloody stool including such as the inflammatory bowel disease.