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61.
We present a case of an elderly woman who presented with neck pain, low-grade fever, bandemia, and a massively elevated erythrocyte sedimentation rate (ESR) who had a cervical epidural abscess. We believe that the selective use of ESR assisted in narrowing the differential diagnosis, as the patient had no neurological deficits and no predisposing factors such as distal infection, immunosuppression, trauma, or recent surgery. Furthermore, in the literature, an elevated ESR is consistently found in patients with epidural abscesses, whereas clinical findings such as fever, leukocytosis, and neurological deficits are only variably present. 相似文献
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Sandeep Agarwala Ankur Mandelia Sameer Bakhshi M. Srinivas Minu Bajpai Arun K. Gupta Devendra K. Gupta Veereshwar Bhatnagar 《Journal of pediatric surgery》2014
Purpose
To evaluate the outcome of children with neuroblastoma (NB) from a tertiary care referral centre in India.Method
All children with NB registered from October 1996 through July 2009 were included in the study. INSS was used for staging. All children included in the study received chemotherapy and radiation therapy appropriate for stage. Tumor resection was done when feasible. The final outcome was overall survival and it was categorized as Complete Response (CR), Partial Response (PR); No Response (NR) and Progressive Disease (PD). Analysis of three-year overall survival was done using Kaplan Meier method and Log Rank test of significance. Multivariate analysis for significance of age, site and stage was performed.Results
144 children in the age range of 1–132 months (median 36) were enrolled. Only 38 (26.4%) children were below 12 months. 112 (77.8%) of the tumors were abdominal and 32 (22.2%) were extra-abdominal. Stage distribution was 1 + 2 in 6 (4.2%); 3 in 58 (40.3%); 4 in 68 (47.2%); 4 s in 12 (8.3%). 83 (57.6%) underwent gross complete resection. At the time of last follow-up, 100 (69.4%) were alive [60 CR (41.7%); 33 PR; 7 PD/NR] and 44 (30.6%) were dead [1CR; 11PR; 32 PD/NR]. The three-year OS was 60.7% [95 CI 50.4–69.5]. The OS was 69.7% for those < 12 months of age [95 CI 51.8–82.0] and CR was achieved in 57.9%, while for those > 12 months the OS was 55.3% [95 CI 42.2–66.6] and CR was achieved in 35.8% (p = 0.73). All 6 (100%) patients with Stage 1 and Stage 2 disease were alive and disease free. The OS was 71.5% for Stage 3[95 CI 55.3–82.7] and CR was achieved in 56.9%, while for Stage 4 the OS was 35.7%[95 CI 19.3–52.4] and CR was achieved in 17.6% (p = 0.001). The OS was 83.3% for 4 s [95 CI 48.2–95.6] and CR was achieved in 75%.Conclusion
All the six children with Stage 1 & 2 achieved CR and were alive, while 57% of Stage 3 could achieve CR and had an OS of 71.5%. The OS (35.7%) and CR (17.6%) for Stage 4 were significantly less (p = 0.001). 相似文献69.