Pepid Pediatric Emergency Medicine Clinical Topics
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Periodontal Assessment and Treatment Planning Gingival description Color: o pink o erythematous o cyanotic o racial pigmentation o metallic pigmentation o uniformity Contour: o recession o clefts o enlarged papillae o cratered papillae o blunted papillae o highly rolled o bulbous o knife-edged o scalloped o stippled Consistency: o firm o edematous o hyperplastic o fibrotic Band of gingiva: o amount o quality o location o treatability Bleeding tendency: o sulcus base, lining o gingival margins Suppuration Sinus tract formation Pocket depths Pseudopockets Frena Pain Other pathology Dental Description Defective restorations: o overhangs o open contacts o poor contours Fractured cusps 1 ww.links2success.biz [email protected] 914-303-6464 Caries Deposits: o Type . plaque . calculus . stain . matera alba o Location . supragingival . subgingival o Severity . mild . moderate . severe Wear facets Percussion sensitivity Tooth vitality Attrition, erosion, abrasion Occlusal plane level Occlusion findings Furcations Mobility Fremitus Radiographic findings Film dates Crown:root ratio Amount of bone loss o horizontal; vertical o localized; generalized Root length and shape Overhangs Bulbous crowns Fenestrations Dehiscences Tooth resorption Retained root tips Impacted teeth Root proximities Tilted teeth Radiolucencies/opacities Etiologic factors Local: o plaque o calculus o overhangs 2 ww.links2success.biz [email protected] 914-303-6464 o orthodontic apparatus o open margins o open contacts o improper -
Food Allergy • Higher Prevalence in Children: Many Food Allergic Children Develop Immune Tolerance Background Ctd
Overview of Food-Related Adverse Reactions ALLSA 2017 Dr Claudia Gray Dr Claudia Gray • MBChB, FRCPCH (London), MSc (Surrey), Dip Allergy (Southampton), DipPaedNutrition(UK), PhD (UCT) • Paediatrician and Allergologist, UCT Lung Institute • Red Cross Children’s Hospital Allergy and Asthma Department • [email protected] Background 1. Food allergies are common: • Infants: 6-10%; children 2-8%, adults 1-2% true food allergy • Higher prevalence in children: many food allergic children develop immune tolerance Background ctd 2. Food allergies are increasing: • Peanut allergy in UK doubled in 1-2 decades: 1.8%. ? Stabilising in some regions Background 3. Spectrum changing: • Multiple food allergies increasing • “Rare” food allergies are increasing e.g. Eosinophilic oesophagitis; FPIES Allergenic Foods • Prevalence of food allergies influenced by geography and diet; egg and milk allergy universally common • Relatively small number of food types cause the majority of reactions: Allergenic Foods Young Children Adults • Cow’s milk • Fin-fish • Hen’s Egg • Shellfish • Wheat • Treenut • Soya • Peanut • Peanut • Fruit and vegetables • Treenut • Sesame • Kiwi • (* persistence likely) Allergenic Foods • A single food allergen can induce a range of allergic reactions e.g. wheat Classification of Adverse reactions to Food Classification of adverse reactions to food Adverse Reaction to food May occur in all Occurs only in some individuals if they eat susceptible sufficient quantity individuals Pharma- Micro- Toxic Food Food (e.g. cological biological scromboid) e.g. e.g food aversion hypersensitivity tyramine poisoning Classification of adverse reactions to food Food Hypersensitivity Non-allergic food Food Allergy hypersensitivity Mixed IgE- Unknown Metabolic IgE- and non Non IgE- e.g. -
Morphologic Diversity in Human Papillomavirus-Related Oropharyngeal Squamous Cell Carcinoma: Catch Me If You Can! James S Lewis Jr
Modern Pathology (2017) 30, S44–S53 S44 © 2017 USCAP, Inc All rights reserved 0893-3952/17 $32.00 Morphologic diversity in human papillomavirus-related oropharyngeal squamous cell carcinoma: Catch Me If You Can! James S Lewis Jr Department of Pathology, Microbiology, and Immunology; Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA As the human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma epidemic has developed in the past several decades, it has become clear that these tumors have a wide variety of morphologic tumor types and features. For the practicing pathologist, it is critical to have a working knowledge about these in order to make the correct diagnosis, not to confuse them with other lesions, and to counsel clinicians and patients on their significance (or lack of significance) for treatment and outcomes. In particular, there are a number of pitfalls and peculiarities regarding HPV-related tumors and their nodal metastases that can easily result in misclassification and confusion. This article will discuss the various morphologic types and features of HPV- related oropharyngeal carcinomas, specific differential diagnoses when challenging, and, if established, the clinical significance of each finding. Modern Pathology (2017) 30, S44–S53; doi:10.1038/modpathol.2016.152 It is now well-established that human papilloma- Among its many effects on clinical practice, the virus (HPV) is responsible for a large fraction of oropharyngeal HPV epidemic has put pathologists at oropharyngeal squamous cell carcinomas (SCC), the forefront of diagnosis and recognition of these particularly in the United States and Europe.1 Many unique tumors, which are much less clinically have termed the increase in HPV-related orophar- aggressive than conventional head and neck SCC, 7 yngeal SCC as an epidemic.2,3 There are numerous and which are beginning to be managed differently. -
Kikuchi Disease with Generalized Lymph Node, Spleen And
Case Report Mol Imaging Radionucl Ther 2016;25:102-106 DOI:10.4274/mirt.25338 Kikuchi Disease with Generalized Lymph Node, Spleen and Subcutaneous Involvement Detected by Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Flor-18-Florodeoksiglukoz Pozitron Emisyon Tomografisi/Bilgisayarlı Tomografi ile Saptanan Yaygın Lenf Nodu, Dalak ve Deri Altı Tutulumu Olan Kikuchi Hastalığı Alshaima Alshammari1, Evangelia Skoura2, Nafisa Kazem1, Rasha Ashkanani1 1Mubarak Al Kabeer Hospital, Clinic of Nuclear Medicine, Jabriya, Kuwait 2University College London Hospital, Clinic of Nuclear Medicine, London, United Kingdom Abstract Kikuchi-Fujimoto disease, known as Kikuchi disease, is a rare benign and self-limiting disorder that typically affects the regional cervical lymph nodes. Generalized lymphadenopathy and extranodal involvement are rare. We report a rare case of a 19-year- old female with a history of persistent fever, nausea, and debilitating malaise. Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) revealed multiple hypermetabolic generalized lymph nodes in the cervical, mediastinum, axillary, abdomen and pelvic regions with diffuse spleen, diffuse thyroid gland, and focal parotid involvement, bilaterally. In addition, subcutaneous lesions were noted in the left upper paraspinal and occipital regions. An excisional lymph node biopsy guided by 18F-FDG PET/CT revealed the patient’s diagnosis as Kikuchi syndrome. Keywords: Kikuchi-Fujimoto disease, histiocytic necrotizing lymphadenitis, fluorine-18-fluorodeoxyglucose Öz Kikuchi hastalığı olarak bilinen Kikuchi-Fujimoto hastalığı, genellikle bölgesel servikal lenf düğümlerini etkileyen, nadir görülen benign ve kendini sınırlayıcı bir hastalıktır. Yaygın lenfadenopati ve ekstranodal tutulum nadirdir. Bu yazıda sürekli ateş, bulantı ve halsizlik şikayetleri olan 19 yaşında bir kadın hasta sunulmaktadır. -
Focus: Blood Cancer
JAN-MAR 17 www.singhealth.com.sg A SingHealth Newsletter for Medical Practitioners MCI (P) 027/11/2016 FOCUS: BLOOD CANCER Haematologic Emergencies An Overview of in the General Practice Myeloproliferative Neoplasms When to Suspect Approach to an Adult with Myeloma in Primary Care Lymphadenopathy in Primary Care SingHealth Duke-NUS Academic Medical Centre • Singapore General Hospital • KK Women’s and Children’s Hospital • Sengkang Health • National Cancer Centre Singapore • National Dental Centre of Singapore • National Heart Centre Singapore • National Neuroscience Institute • Singapore National Eye Centre • SingHealth Polyclinics • Bright Vision Hospital Medical Appointments: 6321 4402 (SGH) Focus: Update Blood Cancer 6436 8288 (NCCS) Haematologic Emergencies in the General Practice Adj Assoc Prof Wong Gee Chuan, Senior Consultant, Department of Haematology, Singapore General Hospital; SingHealth Duke-NUS Blood Cancer Centre Patients with malignant haematological diseases may present with dramatic and life-threaten- ing complications. General physicians must be able to recognise these conditions as prompt treatment can be life-saving. Hyperleukocytosis and leukostasis and febrile neutropaenia in patients with haematologic malignancies are two such conditions highlighted in this article. mental state and unsteadiness in gait. patient presents with a high white cell HYPERLEUKOCYTOSIS AND There is also increased risk of intracra- count and symptoms suggestive of tis- LEUKOSTASIS IN HAEMATOLOGIC nial haemorrhage. sue hypoxia. MALIGNANCIES Besides affecting the central nervous Hyperleukocytosis has been variably system, eyes and lungs, other manifes- Leukostasis constitutes a medi- defined as a total white cell count tations include myocardial ischaemia, cal emergency. Prompt treatment (WBC) of 50 x 109/L or 100 x 109/L. Leu- limb ischaemia or bowel infarction. -
MICHIGAN BIRTH DEFECTS REGISTRY Cytogenetics Laboratory Reporting Instructions 2002
MICHIGAN BIRTH DEFECTS REGISTRY Cytogenetics Laboratory Reporting Instructions 2002 Michigan Department of Community Health Community Public Health Agency and Center for Health Statistics 3423 N. Martin Luther King Jr. Blvd. P. O. Box 30691 Lansing, Michigan 48909 Michigan Department of Community Health James K. Haveman, Jr., Director B-274a (March, 2002) Authority: P.A. 236 of 1988 BIRTH DEFECTS REGISTRY MICHIGAN DEPARTMENT OF COMMUNITY HEALTH BIRTH DEFECTS REGISTRY STAFF The Michigan Birth Defects Registry staff prepared this manual to provide the information needed to submit reports. The manual contains copies of the legislation mandating the Registry, the Rules for reporting birth defects, information about reportable and non reportable birth defects, and methods of reporting. Changes in the manual will be sent to each hospital contact to assist in complete and accurate reporting. We are interested in your comments about the manual and any suggestions about information you would like to receive. The Michigan Birth Defects Registry is located in the Office of the State Registrar and Division of Health Statistics. Registry staff can be reached at the following address: Michigan Birth Defects Registry 3423 N. Martin Luther King Jr. Blvd. P.O. Box 30691 Lansing MI 48909 Telephone number (517) 335-8678 FAX (517) 335-9513 FOR ASSISTANCE WITH SPECIFIC QUESTIONS PLEASE CONTACT Glenn E. Copeland (517) 335-8677 Cytogenetics Laboratory Reporting Instructions I. INTRODUCTION This manual provides detailed instructions on the proper reporting of diagnosed birth defects by cytogenetics laboratories. A report is required from cytogenetics laboratories whenever a reportable condition is diagnosed for patients under the age of two years. -
Very Low Birth Weight Infants
Intensive Care Nursery House Staff Manual Very Low and Extremely Low Birthweight Infants INTRODUCTION and DEFINITIONS: Low birth weight infants are those born weighing less than 2500 g. These are further subdivided into: •Very Low Birth Weight (VLBW): Birth weight <1,500 g •Extremely Low Birth Weight (ELBW): Birth weight <1,000 g Obstetrical history (LMP, sonographic dating), newborn physical examination, and examination for maturational age (Ballard or Dubowitz) are critical data to differentiate premature LBW from more mature growth-retarded LBW infants. Survival statistics for ELBW infants correlate with gestational age. Morbidity statistics for growth-retarded VLBW infants correlate with the etiology and the severity of the growth-restriction. PREVALENCE: The rate of VLBW babies is increasing, due mainly to the increase in prematurely-born multiple gestations, in part related to assisted reproductive techniques. The distribution of LBW infants is shown in the Table: ________________________________________________________________________ Table. Prevalence by birth weight (BW) of LBW babies. Percentage of Percentage of Births Birth Weight (g) Total Births with BW <2,500 g <2,500 7.6% 100% 2,000-2,500 4.6% 61% 1,500-1,999 1.5% 20% 1,000-1,499 0.7% 9.5% 500-999 0.5% 7.5% <500 0.1% 2.0% ________________________________________________________________________ CAUSES: The primary causes of VLBW are premature birth (born <37 weeks gestation, and often <30 weeks) and intrauterine growth restriction (IUGR), usually due to problems with placenta, maternal health, or to birth defects. Many VLBW babies with IUGR are preterm and thus are both physically small and physiologically immature. RISK FACTORS: Any baby born prematurely is more likely to be very small. -
Histamine Poisoning Fact Sheet
Histamine Poisoning Fact Sheet What is Histamine? How much histamine is a harmful dose? Scombroid food poisoning is caused by A threshold dose is considered to be 90 mg/100 ingestion of histamine, a product of the g. Although, levels as low as 5-20 mg/ 100 g could degradation of the amino acid histidine. possibly be toxic; particularly in susceptible Histidine can be found freely in the muscles individuals. of some fish species and can be degraded to What are the symptoms? histamine by enzymatic action of some naturally occurring bacteria. Initial symptoms resemble some allergic reactions which include sweating, nausea, headache and tingling or peppery sensation in the mouth and Which types of fish can be implicated? throat. The scombrid fish such as tuna and mackerel are Other symptoms include urticarial rash (hives), traditionally considered to present the highest localised skin inflammation, vomiting, diarrhoea, risk. However, other species have also been abdominal cramps, flushing of the face and low associated with histamine poisoning; e.g. blood pressure. anchovies, sardines, Yellowtail kingfish, Amberjack and Australian salmon, Mahi Mahi and Severe symptoms include blurred vision, severe Escolar. respiratory distress and swelling of the tongue. Which bacteria are involved? What can be done to manage histamine in seafood? A variety of bacterial genera have implicated in the formation of histamine; e.g. Clostridium, • Histamine levels can increase over a wide Morganella, Pseudomonas, Photobacterium, range of storage temperatures. However, Brochothrix and Carnobacterium. histamine production is highest over 21.8 °C. Once the enzyme is present in the fish, it can What outbreaks have occurred? continue to produce histamine at refrigeration temperatures. -
Orphanet Report Series Rare Diseases Collection
Marche des Maladies Rares – Alliance Maladies Rares Orphanet Report Series Rare Diseases collection DecemberOctober 2013 2009 List of rare diseases and synonyms Listed in alphabetical order www.orpha.net 20102206 Rare diseases listed in alphabetical order ORPHA ORPHA ORPHA Disease name Disease name Disease name Number Number Number 289157 1-alpha-hydroxylase deficiency 309127 3-hydroxyacyl-CoA dehydrogenase 228384 5q14.3 microdeletion syndrome deficiency 293948 1p21.3 microdeletion syndrome 314655 5q31.3 microdeletion syndrome 939 3-hydroxyisobutyric aciduria 1606 1p36 deletion syndrome 228415 5q35 microduplication syndrome 2616 3M syndrome 250989 1q21.1 microdeletion syndrome 96125 6p subtelomeric deletion syndrome 2616 3-M syndrome 250994 1q21.1 microduplication syndrome 251046 6p22 microdeletion syndrome 293843 3MC syndrome 250999 1q41q42 microdeletion syndrome 96125 6p25 microdeletion syndrome 6 3-methylcrotonylglycinuria 250999 1q41-q42 microdeletion syndrome 99135 6-phosphogluconate dehydrogenase 67046 3-methylglutaconic aciduria type 1 deficiency 238769 1q44 microdeletion syndrome 111 3-methylglutaconic aciduria type 2 13 6-pyruvoyl-tetrahydropterin synthase 976 2,8 dihydroxyadenine urolithiasis deficiency 67047 3-methylglutaconic aciduria type 3 869 2A syndrome 75857 6q terminal deletion 67048 3-methylglutaconic aciduria type 4 79154 2-aminoadipic 2-oxoadipic aciduria 171829 6q16 deletion syndrome 66634 3-methylglutaconic aciduria type 5 19 2-hydroxyglutaric acidemia 251056 6q25 microdeletion syndrome 352328 3-methylglutaconic -
Urticaria and Angioedema
Challenging Cases in Allergy and Immunology Massoud Mahmoudi Editor Challenging Cases in Allergy and Immunology Editor Massoud Mahmoudi D.O, Ph.D. RM (NRM), FACOI, FAOCAI, FASCMS, FACP, FCCP, FAAAAI Assistant Clinical Professor of Medicine University of California San Francisco San Francisco, California Chairman, Department of Medicine Community Hospital of Los Gatos Los Gatos, California USA ISBN 978-1-60327-442-5 e-ISBN 978-1-60327-443-2 DOI 10.1007/978-1-60327-443-2 Springer Dordrecht Heidelberg London New York Library of Congress Control Number: 2009928233 © Humana Press, a part of Springer Science+Business Media, LLC 2009 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Humana Press, c/o Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. -
Maternal and Fetal Outcomes of Spontaneous Preterm Premature Rupture of Membranes
ORIGINAL CONTRIBUTION Maternal and Fetal Outcomes of Spontaneous Preterm Premature Rupture of Membranes Lee C. Yang, DO; Donald R. Taylor, DO; Howard H. Kaufman, DO; Roderick Hume, MD; Byron Calhoun, MD The authors retrospectively evaluated maternal and fetal reterm premature rupture of membranes (PROM) at outcomes of 73 consecutive singleton pregnancies com- P16 through 26 weeks of gestation complicates approxi- plicated by preterm premature rupture of amniotic mem- mately 1% of pregnancies in the United States and is associ- branes. When preterm labor occurred and fetuses were at ated with significant risk of neonatal morbidity and mor- tality.1,2 a viable gestational age, pregnant patients were managed Perinatal mortality is high if PROM occurs when fetuses aggressively with tocolytic therapy, antenatal corticos- are of previable gestational age. Moretti and Sibai 3 reported teroid injections, and antenatal fetal testing. The mean an overall survival rate of 50% to 70% after delivery at 24 to gestational age at the onset of membrane rupture and 26 weeks of gestation. delivery was 22.1 weeks and 23.8 weeks, respectively. The Although neonatal morbidity remains significant, latency from membrane rupture to delivery ranged despite improvements in neonatal care for extremely pre- from 0 to 83 days with a mean of 8.6 days. Among the mature newborns, neonatal survival has improved over 73 pregnant patients, there were 22 (30.1%) stillbirths and recent years. Fortunato et al2 reported a prolonged latent phase, low infectious morbidity, and good neonatal out- 13 (17.8%) neonatal deaths, resulting in a perinatal death comes when physicians manage these cases aggressively rate of 47.9%. -
Kikuchi–Fujimoto Disease: Lymphadenopathy in Siblings
Practice CMAJ Cases Kikuchi–Fujimoto disease: lymphadenopathy in siblings Allison Stasiuk BSc Pharm, Susan Teschke MD, Gaynor J. Williams MD MPhil, Matthew D. Seftel MD MPH Patient 1 Key points • Kikuchi–Fujimoto disease is an uncommon and sometimes A 19-year-old Aboriginal woman presented with a three-week familial disorder that should be considered in the history of swollen neck glands, nausea, vomiting, chills and differential diagnosis of cervical lymphadenopathy. weight loss. On examination, she had bilateral, nontender, dif- • Typical presentation includes fever, leukopenia and fuse cervical lymphadenopathy. Oral examination revealed cervical lymphadenopathy. extensive dental caries and periodontal disease. The results of • Although Kikuchi–Fujimoto disease is self-limiting and no her laboratory workup are shown in Table 1. Both a lymph definitive treatment exists, lymph node biopsy is required node aspiration and a bone marrow biopsy were nondiagnostic. to rule out malignancy. The patient was scheduled for a surgical lymph node biopsy, • Patients should be followed closely because of increased but when she was seen one month later, the lymphadenopathy risk for recurrence and for systemic lupus erythematosus. had resolved spontaneously. Based on these findings, she was diagnosed with Kikuchi–Fujimoto disease. At follow-up a year and a half later, she had no evidence of recurrence. of a cervical lymph node in the first sister was nondiagnostic. In the second sister, an excisional biopsy showed geographic areas Patient 2 of necrosis containing apoptotic bodies and a striking degree of karyorrhexis with nuclear debris (Figure 1). Cells within the Two years after the initial presentation of the first patient, her 19- areas of necrosis were highly proliferative; more than 60% of year-old younger sister was assessed for a three-week history of the cells tested positive for the Ki-67 proliferation marker.