Torsion of a mesenchymal hamartoma of the liver in a 1-year-old boy

We report a case of a one-year-old boy who was referred to our clinic suspected of having acute abdomen. On physical examination, the abdomen was soft, diffusely tender with weak peristalsis. Ultrasonography and MRI of the right hemiabdomen demonstrated a well-defined, solid, expansive formation with slightly lobulated contours and an interspersed inhomogeneous structure with overall dimensions of 59?×?45?×?50?mm. After midline laparotomy was performed, a cystic tumor was found, twisted around a pedicle which was arising from the falciform ligament and it measured 5–6?cm in diameter. The tumor appeared to be necrotic. The mass was ligated and extirpated on the pedicle and sent for histopathological analysis. After the surgery, the boy was hemodynamically stable, without respiratory complications and all laboratory findings were within normal limits. Histopathological analysis showed that the tumor was composed of mesenchymal stroma with sparse glimpses of hepatocytes and bile ducts with partly cystic changes lined by orderly epithelium. Given the clinical data, histology and immunohistochemistry analysis (alpha-fetoprotein, CK8/18, hepatocyte, desmin and CD31) a diagnosis of a twisted mesenchymal hamartoma of the liver was made.     

Refining the Baveno VI elastography criteria for the definition of compensated advanced chronic liver disease

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Prevention of bacteremia caused by α-hemolytic streptococci by roxithromycin (RU-28 965) in granulocytopenic patients receiving ciprofloxacin

Summary We previously demonstrated that ciprofloxacin prevents infections caused by gram-negative bacilli in patients with granulocytopenia. However, in patients with intensive cytotoxic treatment leading to severe mucosal damage a high incidence of bacteremias caused by -hemolytic streptococci was seen. In the present study 45 consecutive patients undergoing intensive cytotoxic treatment received a short course of roxithromycin (10 days) in addition to ciprofloxacin for prevention of bacteremias caused by -hemolytic streptococci. The results of this study were compared with the results obtained in previous comparable patients receiving ciprofloxacin alone. During the days with addition of roxithromycin no infections caused by -hemolytic streptococci occurred, while in the control group of 80 patients 16 bacteremias (20%) were seen. Although roxithromycin was shown to antagonize bactericidal action of ciprofloxacin on gram-negative bacilliin vitro, in vivo study based on serum bactericidal titers and on results of surveillance cultures showed no antagonistic interactions.

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Roxithromycin (RU-28 965) zur Prävention der Bakteriämie durch alpha-hämolytische Streptokokken bei granulozytopenischen Patienten unter Ciprofloxacin-Prophylaxe

Zusammenfassung In früheren Studien konnte die präventive Wirksamkeit von Ciprofloxacin gegen Infektionen durch gramnegative Bakterien bei granulozytopenischen Patienten belegt werden. Jedoch traten bei Patienten, die mit intensiven Zytostatikaschemata behandelt wurden, häufig Bakteriämien durch alpha-hämolytische Streptokokken auf. In der vorliegenden Studie erhielten 45 Patienten, die nacheinander eingewiesen wurden und eine hochdosierte Zytostatikatherapie durchmachten, zehn Tage lang Roxithromycin als Zusatz zu einer Prophylaxe mit Ciprofloxacin, um das Auftreten septischer Infektionen durch alpha-hämolytische Streptokokken zu verhüten. Die Ergebnisse dieser Studie wurden denjenigen einer vorausgegangenen Studie mit vergleichbaren Patienten unter Prophylaxe mit Ciprofloxacin allein gegenübergestellt. Während in der Vergleichsgruppe bei 16 von 80 Patienten Bakteriämien durch alpha-hämolytische Streptokokken aufgetreten waren, kam es bei den Patienten, die Roxithromycin erhielten, zu keiner einzigen solchen Infektion, solange dieses Antibiotikum verabreicht wurde. Im Gegensatz zuIn vitro-Beobachtungen, die darauf schließen lassen, daß Roxithromycin die bakterizide Aktivität von Ciprofloxacin gegen gramnegative Bakterien antagonisiert, waren antagonistische Interaktionen in einerIn vivo-Studie anhand der Serumbakterizidietiter und Ergebnisse von Überwachungskulturen nicht festzustellen.

     

Cognitive dysfunction in children with brain tumors at diagnosis

Background

Survivors of brain tumors have a high risk for a wide range of cognitive problems. These dysfunctions are caused by the lesion itself and its surgical removal, as well as subsequent treatments (chemo‐ and/or radiation therapy). Multiple recent studies have indicated that children with brain tumors (BT) might already exhibit cognitive problems at diagnosis, i.e., before the start of any medical treatment. The aim of the present study was to investigate the baseline neuropsychological profile in children with BT compared to children with an oncological diagnosis not involving the central nervous system (CNS).

Methods

Twenty children with BT and 27 children with an oncological disease without involvement of the CNS (age range: 6.1–16.9 years) were evaluated with an extensive battery of neuropsychological tests tailored to the patient's age. Furthermore, the child and his/her parent(s) completed self‐report questionnaires about emotional functioning and quality of life. In both groups, tests were administered before any therapeutic intervention such as surgery, chemotherapy, or irradiation. Groups were comparable with regard to age, gender, and socioeconomic status.

Results

Compared to the control group, patients with BTs performed significantly worse in tests of working memory, verbal memory, and attention (effect sizes between 0.28 and 0.47). In contrast, the areas of perceptual reasoning, processing speed, and verbal comprehension were preserved at the time of measurement.

Conclusion

Our results highlight the need for cognitive interventions early in the treatment process in order to minimize or prevent academic difficulties as patients return to school. Pediatr Blood Cancer 2015;62:1805–1812. © 2015 The Authors. Pediatric Blood & Cancer, published by Wiley Periodicals, Inc.     

Diversity and education of the nursing workforce 2006–2016

Background

The Institute of Medicine (IOM) report, The Future of Nursing, included recommendations to increase nurse diversity, the percent of nurses obtaining a bachelor’s degree, and inter-professional education.

Criteria to Screen for Traumatic Cervical Spine Instability: A Consensus of Chiropractic Radiologists

Objective

The purpose of this study was to establish consensus on a radiographic definition for cervical instability for routine use in chiropractic patients who sustain trauma to the cervical spine.