Davis, Janet L. “Ocular syphilis.” Current opinion in ophthalmology 25.6 (2014):513-8.
Posted in Diagnosis, EUH, Therapy
Magnetic resonance imaging (MRI) is the most effective method for documenting the soft tissue lesions and evaluating their distribution.
In practice, several key points deserve emphasis:
• the absence of MRI abnormalities of the intermuscular fasciae virtually rules out necrotizing fasciitis
• the presence of gas (signal-free areas on all sequences) is highly specific but rare
• extensive thickening of the intermuscular fasciae with an appearance suggesting incomplete vascularization supports a diagnosis of necrotizing fasciitis
• the presence of lesions confined to the peripheral fasciae and to small portions of the adjacent intermuscular fasciae is of borderline significance
Malghem, Jacques, et al. “Necrotizing fasciitis: contribution and limitations of diagnostic imaging.” Joint bone spine 80.2 (2013):146-54.
A very important point is that imaging studies play only an ancillary role and must never delay the surgical treatment of deep necrotizing fasciitis, a condition whose outcomes, including patient survival, depend heavily on the promptness of appropriate therapy
Go to: Chronic thromboembolic pulmonary hypertension (CTEPH)
Select Diagnosis on the left.
Making the diagnosis:
-suspect chronic thromboembolic pulmonary hypertension in patients with(1, 2)
-symptoms of progressive dyspnea on exertion and exercise intolerance
-pulmonary hypertension and history compatible with, but not limited
to, pulmonary embolism
-unexplained pulmonary hypertension
-diagnosis of chronic thromboembolic pulmonary hypertension typically includes
all of the following(1)
-pulmonary hypertension as demonstrated by transthoracic
echocardiography (TTE) and confirmed by right heart catheterization
-systolic pulmonary artery pressure > 40 mm Hg, and mean pulmonary
artery pressure > 25 mm Hg at rest
-pulmonary vascular resistance > 3 Wood units (240 dynes-second-cm-5)
-abnormal pulmonary angiogram or ventilation-perfusion (V/Q) scan showing
persistent obstruction of main, lobar, segmental, or subsegmental pulmonary
arteries despite 3 months of therapeutic anticoagulation
-exclusion of other causes of pulmonary hypertension including exclusion of
left-sided heart disease by pulmonary capillary wedge pressure < 15 mm Hg
Posted in VA
Nigwekar, Sagar U, et al. “Calciphylaxis: risk factors, diagnosis, and treatment.” American journal of kidney diseases 66.1 (2015):133-46.
Gameiro, Ana, et al. “Pyoderma gangrenosum: challenges and solutions.” Clinical, Cosmetic and Investigational Dermatology 8(2015):285-93.
Results of systematic review state, “The diagnosis of an exudate was most accurate if cholesterol in the pleural fluid was greater than 55 mg/dL (LR [likelihood ratio] range, 7.1-250), lactate dehydrogenase (LDH) was greater than 200 U/L (LR, 18; 95% CI, 6.8-46), or the ratio of pleural fluid cholesterol to serum cholesterol was greater than 0.3 (LR, 14; 95% CI, 5.5-38). A diagnosis of exudate was less likely when all Light’s criteria (a ratio of pleural fluid protein to serum protein >0.5, a ratio of pleural fluid LDH to serum LDH >0.6, or pleural fluid LDH >two-thirds the upper limit of normal for serum LDH) were absent (LR, 0.04; 95% CI, 0.02-0.11).”
Wilcox, M E, et al. “Does this patient have an exudative pleural effusion? The Rational Clinical Examination systematic review.” JAMA: the Journal of the American Medical Association 311.23 (2014):2422-31.