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The purpose of this study was to determine the actual diagnostic status of aseptic meningitis and consider the factors that cause difficulties in its diagnosis.This study retrospectively reviewed the medical records of aseptic meningitis treated at our hospital from 2013 to 2022 and compared biometric data to distinguish between timely diagnose and difficult diagnose cases.This retrospective observational study included 127 patients aged 18 years or older. 66 (52.0 %) were female, with a median age of 35.9±15.9 years. The main symptoms were headache (122, 96.1 %), general malaise (110, 86.6 %), vomiting (79, 62.2 %). The 127 patients were classified into two groups: A timely diagnosis group diagnosed within 6 days of symptom onset, and a difficult diagnosis group diagnosed within 7 days or longer. There were significant differences between the two groups in the proportion of patients with a history of antimicrobial treatment and fever above 38 °C, and in the positive rates of neck stiffness and jolt accentuation of headache (JAH). The total number of hospitals involved in the process of diagnosis was significantly higher in the difficult diagnosis group and the length of inpatient stay was significantly longer. Multivariate analysis revealed significant differences in neck stiffness, JAH, and prior antibacterial therapy.Atypical cases, such as neck stiffness and JAH negativity, may make the diagnosis difficult. Clinicians should be aware of this atypical presentation of aseptic meningitis. [ABSTRACT FROM AUTHOR]

An 82-year-old man developed a hypervascular renal tumor, 2 cm in size, and multiple liver tumors. Liver tumors had obscured tumor margins on ultrasonography. Positron emission tomography/computed tomography (PET/CT) showed no areas of avid radiotracer uptake in the liver. Routine pathological examination failed to demonstrate tumor cells in 9 tissue samples obtained from repeated core needle biopsies. Even a frozen section of the liver segment 8 tumor further failed to prove malignant cells, and an additive frozen section of the liver section 2 tumor finally proved atypical cells growing in tubular and solid fashions with eosinophilic cytoplasm. Tumors showed expansive growth patterns, were in direct contact with normal liver cells, had abundant micro-vessels, had only sparse hyalinized septa, and had no pale cells. Immunostaining revealed the tumor cells to be positive for CD10, CD117, and E-cadherin and negative for CK7, and PAX8, leading to the diagnosis of metastatic chromophobe renal cell carcinoma (chRCC) in the liver. Arginase-1 immunostaining clearly demarcated the boundary between the chRCC cells and normal hepatic cells. Diagnostic physicians should note that chRCCs are of low-grade malignancy despite their abundant intra-tumoral blood flow and can often pose imaging and pathologic diagnostic difficulties.

Objectives: The incidence of tuberculous peritonitis has been reported between 0.1% and 0.7% among all tuberculosis types. This study, it was aimed to evaluate the cases with tuberculous peritonitis, which has an important place in the differential diagnosis of patients with ascites, clinically, biochemically, microbiologically, and histopathologically. Methods: Forty-nine patients with a definite clinical, radiological, and histopathological diagnosis of tuberculous peritonitis, which formed the basis of our study, were analyzed retrospectively. Results: The mean age of patients with tuberculous peritonitis was found to be 39.45±19.02 years. Purifiedprotein derivative (PPD) was positive in 23 (72%) of 32 patients with tuberculous peritonitis whose PPD results were recorded, in 9 (28%) PPD results were evaluated as anergic or negative. QuantiFERON-TB Gold In-Tube (QFT-GIT) test was sent in 10 of the patients, the result was positive in 9 (90%) patients and negative in 1 (10%) patient. There were 32 patients in whom tuberculosis polymerase chain reaction (PCR) was studied from ascitic fluid, 7 (22%) of the patients were PCR positive and 25 (78%) negative. Mycobacterium tuberculosis culture positivity was found in 18 (69%) of 26 patients who were biopsied. In total, 29 (59%) of the patients had M. tuberculosis culture positivity. Conclusions: Tuberculous peritonitis constitutes a public health problem in endemic regions of the world and tuberculous peritonitis should be considered in patients presenting with ascites. Despite all diagnostic difficulties, necessary tests, especially peritoneal biopsy, should be performed for early diagnosis, and it should not be forgotten that early initiation of treatment is very important in terms of morbidity and mortality of the disease. [ABSTRACT FROM AUTHOR]

The number of patients with implantable cardioverter-defibrillators (ICDs) is steadily increasing. Postmortem interpretation of the data recorded and stored by the device provides vital information about the time and cause of death. In this paper, we describe a case of a 67-year-old man found on the stairs. He had pulseless electrical activity and multiple fresh injuries, notably to the head. Despite an hour-long resuscitation attempt, it was unsuccessful. The subsequent postmortem examination revealed significant myocardial hypertrophy with post-infarction scarring in the left ventricle, and no significant central nervous system injuries were observed. The patient's ICD was dissected and submitted for analysis. Evaluation of the recorded data revealed the presence of ventricular fibrillation (VF) and tachycardia shortly before the patient was found. Analysis of all the evidence gathered during the investigation led to the conclusion that the cause of death was cardiopulmonary failure resulting from cardiac arrhythmia, and the head injury was a result of an unconscious fall down the stairs. [ABSTRACT FROM AUTHOR]

In recent years, the number of patients with a cardiac implantable electronic device (CIED) has been steadily increasing. Implantable cardioverter-defibrillators (ICDs) are currently one of the primary methods of preventing sudden cardiac death (SCD) in patients at risk. A post-mortem CIED examination, which these days is performed very rarely, as well as the analysis of the recordings may provide key information regarding the circumstances of the patient's death. This applies to both the potential impact of a defect or damage to the device in an event of the owner's death and the forensic analysis of the circumstances of death, especially when traditional post-mortem diagnostics do not provide a clear diagnosis. In addition, using the data stored on the device, it is possible to identify the corpse and precisely determine the time of death, which is crucial for the conducted expertise. Since it is a quick, cheap and widely available procedure, CIED analysis should be incorporated as a routine element of post-mortem diagnostics. [ABSTRACT FROM AUTHOR]

Copyright of Logopaedica Lodziensia is the property of Wydawnictwo Uniwersytetu Lodzkiego and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Logopaedica Lodziensia is the property of Wydawnictwo Uniwersytetu Lodzkiego and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Child abuse may take different forms. Munchausen syndrome by proxy is a factitious disorder in which disease symptoms are induced in a dependent person so that the perpetrator could play the role of a caregiver. Parent (mother in most cases) is usually the perpetrator, and a child is usually the victim. The desire to draw the attention of medical personnel, which can be a psychological reward, is the main motivation for a person affected by Munchausen syndrome by proxy. The scale of the problem remains unknown due to diagnostic difficulties. We present a case of a 10-year-old girl who was initially hospitalised for more than 2 months due to unexplained bleeding from the lower gastrointestinal tract, and was then admitted to another paediatric unit due to consciousness disorders. Accurate diagnosis and prevention of further child maltreatment was possible due to collecting thorough medical history, diagnostic vigilance and cooperation between medical centres where the girl was hospitalised.

Actinomycosis is neglected, an uncommon disease caused by bacteria. The greatest difficulty in correct and early diagnostics of actinomycosis is the fact that it often mimics other conditions. The difficulties in diagnostic of actinomycosis result in misdiagnosis, lengthening the patient's treatment time, unnecessary surgical treatment and sometimes dangerous complications. Aim of the article: The aim of the article is to familiarize readers with the rarest conditions that have been mistaken for actinomycosis.

Introduction. The parotid gland, the largest salivary gland, can be the site of various pathology. Any swelling located in the parotid gland requires thorough investigations. Symptoms usually include a painless, unilateral tumor, with a slow evolution. Histology establishes the therapeutic plan. Case presentation. We present the case of a 60 years-old patient, known with a tumoral mass in the parotid region for 3 years, who came to our clinic for a history of 3 months persistent dysphonia. Endoscopic laryngoscopy revealed a tumoral mass occupying two thirds of the right vocal cord, covered in keratin plates, with normal mobility of both vocal cords. From the patient’s record, we note an ultrasound fine needle aspiration biopsy, performed at the onset of the parotid tumoral mass, which did not reveal any malignancy criteria. Conclusions. Differential diagnosis for parotid gland pathology must include inflammatory, infectious and tumoral conditions. A complete set of investigations must be performed in order to establish the therapeutic approach. Treatment, depending on the histological type of the tumor, is commonly surgical and can be followed by radiotherapy and in some cases, chemotherapy.

Salivary gland tumours are one of the most difficult areas of diagnostic pathology, with significant morphological diversity and many overlapping features. The latest WHO classification has attempted to simplify the classification but there are still more than 30 tumours for the pathologist to grapple with. These include two new entities – secretory carcinoma and sclerosing polycystic adenosis – and a number of name changes. Most controversial is the removal of "low grade" from polymorphous low-grade adenocarcinoma and the inclusion of intraductal carcinoma as a unifying entity. There are also more nuanced changes in categorisation or terminology that may influence the way a diagnostic report is written. Despite advances in immunohistochemistry and molecular pathology, the WHO still use histomorphology as the primary basis for classification. However, morphological similarities can make diagnosis difficult without the assistance of ancillary techniques. In this short review we describe these changes in the latest WHO classification, discuss particular areas of diagnostic difficulty, and suggest some useful antibodies that can be used to assist diagnosis. [ABSTRACT FROM AUTHOR]

Aim: The aim of this article is to discuss the difficulties and complexities of the bipolar affective disorder (BPAD) diagnostic process in an adolescent. The case of suspected occurrence of bipolar affective disorder in an adolescent who was diagnosed with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in childhood was presented. Case report: A 16-year-old boy was treated in the past for ADHD and ODD. The reason for the current admission to the pediatric psychiatry ward was the behavioral change that disturbed the caregivers: he has become more restless, irritable, explosive. A few nights prior to hospitalization, he was very agitated, chaotic, physically and verbally aggressive. At admission he was disorganized, tense, in strong hand manipulation anxiety. He displayed alternating attention and loquacity. His statements were chaotic, his thinking accelerated. He displayed grandiose delusions. He was uncritical. After the treatment, mood, psychomotor drive and circadian rhythms stabilisation were achieved. Discharged from the ward with the recommendation of further outpatient treatment and continuation of psychotherapeutic interactions. Conclusions: 1. The diagnosis of bipolar affective disorder in adolescents is a complex and difficult process. The expression of symptoms of this disorder during adolescence is different than in adults. 2. Differential diagnosis of bipolar affective disorder for a 16-year-old boy should also consider both past ADHD and ODD and their possible sequelae should be taken into account, as well as the risk of abnormal personality development. 3. Due to the high dynamics of changes associated with the adolescence period, further pharmacological treatment of bipolar affective disorder should be combined with psychotherapeutic interventions. [ABSTRACT FROM AUTHOR]

In connection with the polymorphism of clinical manifestations of dermatomyositis, patients in the onset of the disease can apply to doctors of any specialty. However, the statement of this diagnosis causes considerable difficulties for practical doctors who do not work in the field of rheumatology. To a large extent this is due to the fact that inflammation of the muscle tissue can have not only an autoimmune origin, but also be observed with a variety of infections and intoxications. Diagnosis of dermatomyositis is associated with the need to eliminate tumor processes in the body, accompanying it in 20% of cases. The article presents a clinical case of subacute dermatomyositis, which occurred in a man 49 years after massive insolation against the background of photosensitization with fluoroquinolones in the treatment of prostatitis. After detecting a significant increase in the level of serum “muscle” enzymes and electromyographic signs of inflammatory myopathy, a patient with characteristic progressive symmetrical muscle weakness of the proximal limb and skin changes was diagnosed with primary idiopathic dermatomyositis with the activity of III degree. Diagnostic search required the exclusion of infectious and neoplastic diseases. Timely formulation of the diagnosis made it possible in time to prescribe immunosuppressive therapy with glucocorticosteroids, achieving a decrease in the activity of the disease and improving the prognosis.

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating or axon-damaging polyneuropathy. It is characterized by sensory, motor and reflex disorder, damaged cranial nerves, autonomic disorders, and, less frequently, damage to the central nervous system. This is a life-threatening condition that urges patients to seek emergency treatment for progressive pain, paralysis and/or respiratory distress that can cause death in the absence of timely treatment. Early diagnosis and treatment of this condition are very important in preventing fatal outcome. Although many infections are associated with the etiology of GBS, correlation with Lyme disease is determined very rarely. Lyme disease is a tick-borne Borrelia burgdorferi infection that can cause lesions of multiple organ systems: usually the skin, joints, nervous system, and the heart. This case report presents an 8-year-old boy who was admitted to the hospital because of progressive weakness in the extremities, meningeal signs, bilateral facial nerve paresis, and areflexia. The patient was diagnosed with GBS and Lyme disease; and symptoms of the patient gradually disappeared following the treatment with intravenous immunoglobulin and ceftriaxone. Although the diagnosis of GBS was definite, the diagnosis of Lyme disease was complicated by a variety of circumstances which we analyse in this article. We also discuss a possible connection between the two pathologies.

In some non-small cell lung cancer (NSCLC) patients, lipid-poor adrenal adenomas cannot be adequately differentiated from metastases using imaging methods. Invasive diagnostic procedures also have a low negative predictive value (NPV) in such cases. The current study aims to establish a specific and clinically practical metabolic parameter for lipid-poor adrenal lesions (ALs) in NSCLC patients. This diagnostic approach may prevent unnecessary abdominal enhanced computed tomography (CT), magnetic resonance imaging, or invasive diagnostic procedures. Sixty-four NSCLC patients with 69 lipid-poor ALs and 28 control patients with 30 benign lipid-poor ALs, who underwent FDG-PET/CT, were retrospectively reviewed. Two morphological and four metabolic parameters were analyzed in FDG-PET/CT images of NSCLC and control patients. Baseline and post-chemotherapy images of 64 NSCLC patients were re-evaluated according to the PERCIST 1.0. In cases where ALs could not be differentiated, follow-up FDG-PET/CT images were re-examined. The receiver operating characteristic (ROC) curve method was used for the evaluation of diagnostic parameters. Out of 69 ALs, 39 were determined as metastatic lesions (adrenal metastasis), while 30 lesions were considered non-metastatic (adrenal adenomas). The mean attenuation value, SUVmax AL/SUVmax primary tumor, SUVmax, SUVmax AL/liver, and SUVmax AL/SUVmean liver were significantly different between metastatic and benign ALs from NSCLC patients. The SUVmax AL/SUVmean liver ≥1.81 had the best positive (PPV, 94.3%) and negative (NPV, 82.4%) predictive values, and the highest specificity (93.3%), sensitivity (84.6%) and accuracy (86.9%). Lipid-poor ALs with SUVmax AL/SUVmean liver ≥1.81 can be accepted as malignant in NSCLC. However, if SUVmax AL/SUVmean liver is

Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A “clinical mask” suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient’s life improved significantly.

Ulcerative colitis (UC) is a chronic re-occuring inflammatory disease affecting mainly the colon. It is more prevalent in the United Kingdom, North America Scandinavia and less common in southern Europe, Asia and Africa. Commonly, UC is suspected in patients presenting with bloody diarrhoea, tenesmus, abdominal pain, and, when severe, weight loss, fatigue, and vomiting. Perhaps one child so far with UC has been reported south- west geo-political zone of Nigeria. We here report the first case of ulcerative colitis in a child in south-south Nigeria. The objective of this report was to highlight the occurence of ulcerative colitis in a Nigerian child in the setting of poor socio- psychological/economic background coupled with difficulty in investigating patient to arrive at a diagnosis. An 11 year old Nigerian male child who was referred to the University of Calabar Teaching Hospital with bleeding per rectum, abdominal pain and swelling, bilateral leg swelling and weight loss for seven months prior to presentation. Examination and investigations done including colonoscopy, histology of biopsy, faecal calprotectin and pANCA confirmed ulcerative colitis. Ulcerative colitis though rare in Africa may have been missed in some children due to mis-conception and lack of diagnostic facilities/expertise. We may begin to see more of this with increasing interest in the sub- specialty of paediatric gastroenterology and presence of diagnostic facilities.

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Introduction and aim. Primary central nervous system lymphoma is a rare, clinically aggressive tumour of the lymphatic system localising 80-90% to the cerebral hemispheres. The rest are located in the spinal cord, cranial nerves or eyeballs. More than 90% of PCNSL cases originate from B lymphocytes. The incidence of the tumour has increased and it develops not only in immunocompromised, but also in immunocompetent individuals. Description of the case. A 47-year-old female patient presented to the Department of Neurology with sudden speech, behaviour and orientation disturbances preceded by severe headaches. The investigations performed indicated a multifocal brain injury of unknown aetiology, most likely inflammatory. After one month, the patient's condition deteriorated despite treatment and she was readmitted to the neurology department. Brain MRI and spectroscopy performed at the beginning of her hospitalisation revealed progression of previous lesions, however, the perfusion result did not indicate a neoplastic process. The investigations suggested acute haemorrhagic encephalomyelitis. Overnight, the woman's neurological condition worsened and there was a significant progression of poor general condition - inertia and increased muscle tone in the left limbs were demonstrated and the patient needed oxygen therapy and catheterisation. 2 weeks after the start of hospitalisation, lesions present on MRI raised the suspicion of lymphoma/glioma. A biopsy was recommended, which revealed PCNSL, an intravascular large B-cell lymphoma. Conclusion. Primary CNS lymphoma is associated with a poor prognosis. Its correct diagnosis is associated with major diagnostic problems and therapeutic difficulties. The course of PCNSL is usually aggressive and the results of treatment are unsatisfactory. [ABSTRACT FROM AUTHOR]

Objective: Aim: Our study aimed to present diagnostic problems in the case of hypercortisolism, pheochromocytoma, hypertension, type 2 diabetes, and chronic kidney disease., Patients and Methods: Materials and Methods: Description of a patient with resistant hypertension admitted to the Department of Endocrinology for hormonal diagnostics. The results of hormonal tests and imaging tests before the procedure were analyzed, and the patient's condition was checked after the procedure. The analysis was extended with a literature review, considering the diagnostic problems in the described case. Electronic databases were the primary way to search, mainly MEDLINE and PubMed. We described a case of a 61-year-old woman diagnosed with right adrenal pheochromocytoma, hypercortisolemia, chronic kidney disease, drug-resistant hypertension, type 2 diabetes, and hypercholesterolemia. During hospitalization in the Department of Endocrinology, i.a., imaging tests and tests to assess adrenal function were performed. During the diagnostic process, a decision was made to perform surgical treatment of the pheochromocytoma, resulting in clinical improvement of the patient's condition., Conclusion: Conclusions: The described case presents diagnostic problems endocrinologists face in the coexistence of several diseases. Often, the diagnosis to make a final diagnosis is complicated, hindered by the patient's multi-morbidity, as well as by the medications taken. There are few studies analyzing the coexistence of the diseases as described by us and their impact on the results of diagnostic tests that would facilitate the diagnosis.

Trichinosis is a parasitic disease caused by the larvae of Trichinella spp. (mostly Trichinella spiralis), introduced into the body through the consumption of undercooked infected meat. Gastrointestinal symptoms are most common in early disease. Clinical picture is completed quickly with myalgia, facial edema, fever, fatigue, headache. Leukocytosis and eosinophilia are characteristic biological changes. Positive diagnosis can be difficult, the disease can be confused with many other diseases (gastroenteritis, myopathies, other parasitic diseases, hipereosinophilic syndrome, febrile disease, skin allergies etc.), especially in the absence of epidemiological suggestive data. We present the case of a patient admitted in the Infectious Diseases Hospital of Brasov in January with acute nonspecific enterocolitis, superimposed over a trichinosis in evolution, diagnosed after admission based primarily on changes in laboratory tests (leukocytosis and eosinophilia) and then on a recent acute febrile dyspeptic episode identified in the history of the patient and on epidemiological data suggestive of trichinosis (consumption of pork infested with larvae of Trichinella spiralis). The conclusion that emerges is that trichinosis diagnosis can be difficult and complete medical history of the patient, especially epidemiological data, is essential. [ABSTRACT FROM AUTHOR]

Background Necrotizing fasciitis is characterized by a fulminant destruction of the soft tissue with an alarmingly high mortality rate. One of the main reasons for the continued high mortality is due to the challenge to punctual recognize and diagnose this disease, as specific cutaneous signs can vary or even be missing early in its evolution - especially in case of simultaneous first manifestation of an acute leukemia. Case presentation An untypical case of necrotizing fasciitis disease in a young patient with the first diagnosis of acute myeloid leukemia is presented. After her induction chemotherapy the only presenting clinical sign was fever in the presence of severe neutropenia without an evident infectious focus. After a few days a painless confluent, erythematous, pustular skin rash with a central necrosis on lateral thigh appeared. Escherichia coli was isolated from blood cultures. Surgical debridement was performed and showed subcutaneous tissue, fascia and underlying muscle around the site of initial cutaneous manifestation with typical necrosis on exploration. But, initially taken skin biopsy did not show any typical histopathological findings like bacteria or inflammatory cells confirming necrotizing fasciitis. Nevertheless, the intraoperative findings were impressive and highly indicative for a necrotizing soft tissue infection, so that the patient was treated according to clinical guidelines with extensive recurrent surgical debridement, broad-spectrum antibiotics and intensive care therapy. After recovering from NF, she successfully underwent further chemotherapy and stem cell transplantation. Conclusion The presented case highlights the risk of potential misinterpretation, delayed diagnosis and treatment of necrotizing fasciitis in patients presenting with an untypical clinical and histopathological manifestation of necrotizing fasciitis as a result of severe neutropenia following chemotherapy for acute myeloid leukemia. [ABSTRACT FROM AUTHOR]

Background Amoebic liver abscess (ALA) is a common and major health problem in India. ALA has a highly variable presentation, causing diagnostic difficulties. Early and correct diagnosis of Amoebic liver abscess is essential, because delayed diagnosis and treatment leads to complications which has significantly higher morbidity and mortality than uncomplicated disease. Objective To find out different clinical presentation and its differential diagnosis in order to establish early diagnosis of ALA. Patients and Methods This retrospective, observational study was carried out in the Department of Surgery during February 2010 to May 2013. Inclusion criteria were defined. The data of patients were enrolled according to variables in performa predesigned for this study and analyzed. Results 187 cases of ALA were enrolled with male to female ratio of 2.8:1. Right hypochondrial pain occurred in 69.52%, left hypochondrial pain occurred in 6.41%, pain radiating to tip of right shoulder in 8.02%, fever in 86.64%, co-incident diarrhea in 36.37% and concurrent pulmonary symptoms in 12.84%. The most common signs were tender hepatomegaly in 73.74% and jaundice in 17.65%. 3.20% patients had past history of aspiration of ALA. 23.52% patients had ruptured abscess. 11.12% were due to delayed diagnosis and 1.60% was ruptured despite treatment. Mortality rate was 3.20% amongst patients with ruptured ALA. Diabetes, hypertension, AIDS and alcoholism were commonly associated co morbidities. Right lobe (82.36%) is commonly involved than left lobe and single abscess (83.42%) was more common than multiple abscess. Diagnosis was missed in 30.48% patients particularly those with atypical presentations. Ultrasonography, Computerized tomography (CT) scan with diagnostic aspiration were useful in diagnosing ALA. Conclusion The typical features of ALA, which include pain, fever and tender hepatomegaly, are nonspecific. ALA may be missed because of variable clinical features and atypical presentation. A high index of clinical suspicion in patients from an endemic area and low socioeconomic class combined with ultrasonography, US aspiration and CT scan will improve the diagnostic accuracy to reduce catastrophic complication as a result of delayed diagnosis. [ABSTRACT FROM AUTHOR]

Clinical assessment of women with pelvic pain was a poor indicator of disease seen at laparoscopy. Thus, of 109 women, 22 at laparoscopy had salpingitis, 19 had adhesions without salpingitis, 20 had endometriosis or ovarian pathology and 48 no observable abnormality. In all laparoscopic categories, Ureaplasma spp. and Mycoplasma hominis, but not Mycoplasma genitalium, were at least as common in the cervix/vagina as Chlamydia trachomatis and equally frequent in the endometrium. However, C. trachomatis had the greatest propensity for spread to the Fallopian tubes. Thus, of 28 women who had C. trachomatis organisms in the vagina/cervix, 13 had them in a Fallopian tube (ratio 2.2:1); the ratio was 6:1 for Neisseria gonorrhoeae, 8:1 for M. genitalium, 21:1 for M. hominis and 31:1 for Ureaplasma spp. M. hominis organisms in a large number were detected most often in women with salpingitis. The likelihood of spread of Ureaplasma urealyticum and U. parvum from the lower to the upper genital tract was about the same and they were detected only once each in a tube, which was not inflamed in either case. Multiple bacteria were often detected at a single site, making it difficult to establish the exact cause of disease. However N. gonorrhoeae was considered to be the sole cause of salpingitis in one woman and the primary or equal primary contributor in four others; C. trachomatis was involved in at least 11 women, mostly as the sole cause or as the primary contributor; M. genitalium was considered the cause in one woman and had possible involvement in three others; and M. hominis was a questionable sole cause in one woman and the primary or equal primary contributor in three. Serologically, C. trachomatis was related to adhesions, without salpingitis, more often (63%) than any other micro-organism. M. genitalium may have been implicated in one case. Serologically, a previous C. trachomatis infection was indicated in 40% of women without an observable laparoscopic abnormality. C. trachomatis in the endometrium and tubes of women without any laparoscopic abnormality suggests subclinical disease, endometritis or endosalpingitis. There was evidence for a smaller proportion (19%) of women without an abnormality having been infected previously with M. genitalium. To some extent this is consistent with the infrequency of acute M. genitalium infections in this cohort of women. [ABSTRACT FROM AUTHOR]

Bilateral, simultaneous quadriceps tendon rupture (QTR) represents a rare entity and delay in establishing the correct diagnosis is not uncommon. Another three cases are reported here and in all the correct diagnosis was missed initially. A review of the English and German literature retrieved 105 cases of bilateral, simultaneous QTR and in 32 patients (30.5%) the correct diagnosis was established with delay. In 28 cases—representing 25 men (89.3%) and 3 women (10.7%)—sufficient data was available for further analysis. In the majority of patients ( n = 19/28; 67.9%) rupture was associated with trauma, while no trauma was reported in 9/28 cases (32.1%). No direct correlation between age and the kind of rupture form (traumatic/spontaneous) could be detected ( P = 0.35). Most partients ( n = 18/28; 64.3%) presented risk factors associated with QTR and obesity ( n = 6/28; 21.4%) was most frequently encountered. A direct association between the rate of risk factors and the rupture form was not seen ( P = 0.5). Overall diagnostic delay lasted 64.7 days on an average (traumatic ruptures 67.7 days/spontaneous ruptures 58.7 days) with this period being longer than 2 weeks in 51.9% and longer than 3 months in 33.3% of patients. Delay varied distinctly in different medical institutions as this period lasted in hospital departments 93.9 days, in ambulances 24 days and in General Practitioners 7.6 days on an average. Initially 25 incorrect diagnoses were established in 21/28 (75%) patients, while 7/28 cases (25%) were discharged initially without any diagnosis. Clinical examination revealed most often palpable suprapatellar gaps ( n = 17/24) and effusions ( n = 13/24), while the classic trias of painful swelling, suprapatellar gap and loss of knee extension was found in only 58.3% of reported patients ( n = 14/24). The correct diagnosis of bilateral QTR was established in 60.7% ( n = 17/28) by history and clinical examination alone. In 10.7% ( n = 3/28) clinical suspect was supported by sonography and in 14.3% ( n = 4/28) by MRT; in 14.3% ( n = 4/28) the correct diagnosis represented a by chance finding during diagnostic or operative procedures of other indication. In 52 tendons detailed information about repair was provided and most often transosseous fixation ( n = 30/52; 57.7%) and direct repair ( n = 14/52; 26.9%) were used, while a tenoplasty was performed in only 15.4% ( n = 8/52). Only 34.6% of patients ( n = 9/26) with follow-up data ( n = 26/28) reported a full recovery with a trend that early surgical repair (limit 2 weeks) improves the final outcome. [ABSTRACT FROM AUTHOR]

Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The authors present a clinical case of esophageal foreign body with exclusive respiratory symptomatology, which generated significant diagnostic difficulties. Careful and detailed anamnesis, coupled with a broad range of investigations enabled us to establish the correct diagnosis and proper treatment. [ABSTRACT FROM AUTHOR]

The case history is described of a patient with sickle cell anemia who developed a unilateral infarct of the mandible following a sickle cell crisis. The interruption of the blood supply resulted in an anesthesia of the inferior dental nerve and pulpal necrosis of otherwise sound premolar and molar teeth. The diagnostic and management difficulties of the case are discussed, and recommendations are made for the treatment of such patients in light of the problems encountered. [ABSTRACT FROM AUTHOR]

Fifteen patients (10 familial and 5 sporadic cases) with facioscapulohumeral dystrophy were studied with regard to the presence of inflammatory changes. Mononuclear infiltrations were not characteristic of any stage of the disease, but they may be present in differring degrees during the whole course of the process. However, their lack or presence was uniform in the affected families, suggesting that the appearance of infiltrations may be genetically determined. Parallel with the presence of cell infiltrations, the serum creatine kinase (CK) activity was moderately increased and the progress of the disease was slightly accelerated. The relation of these phenomena to polymyositis and the diagnostic difficulties are discussed. [ABSTRACT FROM AUTHOR]

The vast majority of melanoma lesions show typical dermoscopic features such as the presence of atypical pigmented network, the variety of colors within nevi, the asymmetry of structures and the presence of structureless areas. The clinical appearance of melanocytic lesions evolving over time also constitutes a clue to discover their malignant potential. Albeit there are some cases that do not exhibit typical dermoscopic and clinical findings suggesting their malignant potential., A Case Report: We report 4 cases of melanoma with their equivocal dermoscopic images and ambiguous clinical pictures. We acknowledge dermoscopic features such as: the presence of variform, peripheral globules suggesting the possible growth of the nevus, the presence of terminal hair within the melanoma lesion and we confirm that only on the basis of this criterion we cannot qualify such melanocytic lesions to the benign category. We also report the case of the two-component lesion consisted of reticular-homogenous pattern and concentrated globules in the superior pole of the nevus with no significant signs of evolution during one year period of surveillance and the case of the two-component lesion consisted of reticular - homogenous pattern with focal areas of higher density network and the presence of polymorphous, dotted, coiled, comma-like vessels which met the criterion of the ugly duckling sign. Dermoscopy is the most useful noninvasive diagnostic tool designed to discriminate skin nevi. Despite its benefits, the interpretation of a dermoscopic image is not always unequivocal. Some melanoma lesions exhibit only single features included in the assessment algorithms used in everyday dermatological practice such as: the ABCDE rule, the pattern analysis, the 7-points Glasgow checklist, the Menzies method, the 3-point checklist. The presence and the shape of vessels within nevi also constitute an important diagnostic indicator of melanoma. Dotted vessels are related to early stages of melanoma and polymorphous, elongated, linear, vessels are connected with more advanced stages. Therefore, dermoscopic examination should be performed by trained physicians. In case when predicted biological potential of melanocytic lesions is uncertain the excision of suspected lesions followed by histopathological examination should be carried out., (© 2021 MEDPRESS.)

The World Health Organization regards chronic pain to be a public health concern. In clinical medicine, fibromyalgia (FM) is the most prevalent chronic widespread pain disease. In terms of impairment, consumption of health and social resources, and impact on primary and speciality care systems, it has reached worrisome proportions. This disease is frequently managed by primary care providers. Because of its intricacy, fibromyalgia diagnosis and treatment can be difficult. Fibromyalgia is a controversial condition. It might appear ill-defined in comparison to other pain conditions, with no clear knowledge of pathophysiology and hence no particular targeted therapy. This invariably sparks debates and challenges. There is no obvious cut-off point that distinguishes FM from non-FM. The diagnosis of fibromyalgia has been complicated by several factors, including patients' health-seeking behaviour, symptom identification, and physician labelling of the disease. Fibromyalgia is currently considered a centralized pain condition, according to research that has improved our understanding of its etiopathology. A multidisciplinary strategy combining pharmacological and non-pharmacological therapies based on a biopsychosocial paradigm can result in effective therapy. Cultural and psychosocial variables appear to be a recent development in fibromyalgia, and they appear to have a larger influence on physician diagnosis than severe symptom levels in FM patients. Although physicians rely on FM criteria as the only way to classify FM patients in research and clinical settings, some crucial elements of the diagnostic challenge of fibromyalgia remain unsolved - invalidation, psychosocial variables, and diverse illness manifestation are some examples. Beyond the existing constructional scores, physicians' judgment gained in real communicative contexts with patients, appears to be the only dependable route for a more accurate diagnosis for fibromyalgia. We have performed an exhaustive review of the literature using the keywords "Fibromyalgia", "challenges" and "diagnosis" in PubMed and Google Scholar indexes up to September 2021. This article aims to examine the causes, diagnosis, and current treatment protocols of FM, as well as discuss some continuing debates and diagnostic challenges which physicians face in accurately diagnosing fibromyalgia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Qureshi et al.)

We present a case of renal cell carcinoma with solitary metastases to the thyroid, the post-nephrectomy scar and the lungs, appearing during an 18-year period following nephrectomy. [ABSTRACT FROM PUBLISHER]