Excruciating Low Back Pain After Strenuous Exertion: Beware of Lumbar Paraspinal Compartment Syndrome.

Background: Low back pain is extremely common and usually a minor self-limiting condition. Rarely, however, it is a harbinger of serious medical illness. Paraspinal compartment syndrome is a rare condition, but its timely recognition is important to allow adequate treatment.

Characteristics of older adults admitted to the emergency department (ED) and their risk factors for ED readmission based on comprehensive geriatric assessment: a prospective cohort study.

Background: Patients aged 75 years and older represent 12% of the overall emergency department (ED) population, and this proportion will increase over the next decades. Many of the discharged patients suffer an unplanned readmission in the immediate and midterm post-discharge period, suggesting under recognition of psychosocial, cognitive and medical problems. The aim of this study was to compare the characteristics of older patients admitted and discharged from the ED and to determine independent predictors for ED readmission 1 month and 3 months after ED discharge based on comprehensive geriatric assessment (CGA).

Tackling fever and inflammation of unknown origin: the do's and don'ts.

Fever and inflammation of unknown origin continue to challenge the clinician. The differential diagnosis is broad and potential diagnostic pitfalls abound. To guide the approach, the authors discuss the do's and don'ts.

Mortality in patients presenting with fever of unknown origin.

Background: Few data exist on the contemporary prognosis of patients presenting with fever of unknown origin (FUO).

Methods: The data of 436 adult immunocompetent patients presenting with FUO between 2000 and 2010 and followed for at least 6 months were analyzed, with a focus on FUO-related deaths. The following variables were assessed in survivors and non-survivors: age, underlying diagnosis, and, in a nested case-control design, fever periodicity, selected laboratory parameters (including peripheral blood counts, enzymes, and inflammatory markers) and organomegaly.

Canakinumab in Schnitzler syndrome.

Objectives: Daily injections of anakinra, an interleukin-1-receptor antagonist, have been reported to control effectively the symptoms and signs of Schnitzler syndrome, a rare acquired autoinflammatory disorder, presenting in adulthood by intermittent fever, urticarial rash, and paraproteinemia, usually IgM. Canakinumab, a fully human interleukin-1β monoclonal antibody, approved for the cryoporin-associated periodic syndrome, may offer a practical advantage because its half-life of ∼28 days may allow less frequent dosing. The present trial was designed to test canakinumab in patients with Schnitzler syndrome.

Adult-onset Still's disease: still a diagnosis of exclusion. A nested case-control study in patients with fever of unknown origin.

Objectives: Several sets of criteria have been proposed to classify adult-onset Still's disease (AOSD), those of Yamaguchi being the most commonly used. The Yamaguchi criteria demand the exclusion of other conditions. A clinical scale, recently proposed by Crispin et al.

Metabolism of ferulic acid during growth of Lactobacillus plantarum and Lactobacillus collinoides.

Background: Food-isolated lactic acid bacteria can transform ferulic acid (FA) into several products. Since quantification of these metabolites during the different bacterial growth phases is lacking, the aim of this study was to identify and quantify conversion products of FA and to follow the kinetics of FA metabolism during growth of Lactobacillus plantarum and Lactobacillus collinoides.

Results: Lactobacillus plantarum and Lactobacillus collinoides were incubated in MRS broth, to which different amounts of FA were added (final concentrations of 0, 0.

Lymph node biopsies in a general internal medicine department: algorithm or individualized decision-making?

Background: Lymphadenopathy (LA) imposes a diagnostic challenge in internal medicine. Exclusion of malignancy is the primary concern.

Methods: A retrospective case series, including 40 adult patients from the general internal medicine department who underwent lymph node biopsy (LNB) at a single university hospital.

A simple tool to improve medication reconciliation at the emergency department.

Background: Medication histories acquired upon admission are often incomplete. Using a standardized approach warrants more complete medication reconciliation, however, this is too time consuming to be performed. Other strategies guaranteeing complete medication histories should be explored.

Diagnostic yield of syncope investigation (initiated) in the emergency department: a pilot study.

Objective: To determine the diagnostic yield of investigations in patients presenting to the emergency department (ED) with syncope. To determine the cause of the syncope.

Patients And Methods: We retrospectively identified consecutive patients presenting to the ED who underwent investigations for syncope at a 1900 bed university teaching hospital during 4 months.

Short-term return visits of 'general internal medicine' patients to the emergency department: extent and risk factors.

Objectives: Although emergency department (ED) return visits are a significant problem universally, it has not been previously studied in our ED. The aim of this study was to determine the extent of the problem in our ED, to identify the relevant clinical predictor variables and to detect diagnostic errors.

Methods: A retrospective observational study of ED return visits by patients managed by the General Internal Medicine (GIM) service was performed.

Inflammation of unknown origin versus fever of unknown origin: two of a kind.

Objectives: A vast literature exists on fever of unknown origin (FUO), characterized by prolonged and perplexing fevers >38.3 degrees C. In contrast, no studies are available to guide the approach to inflammation of unknown origin (IUO), defined as prolonged and perplexing inflammation with temperatures <38.

Endogenous carbon monoxide production: a rare and detrimental complication of extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) is a technique that can support gas-exchange and cardiac function in patients with acute respiratory or cardiac failure that is not responsive to conservative treatment. ECMO is a high-risk procedure in critically ill patients and both technical and patient-related complications frequently occur. We report on a patient with end-stage pulmonary fibrosis (histiocytosis x), in whom ECMO was used as bridge to urgent lung transplantation.

Establishment of reference values for immunoglobulins in the cryoprecipitate.

Cryoglobulins are often estimated by determining cryocrit or total protein content in the cryoprecipitate, but these are only indirect measures. Direct quantification of immunoglobulins in combination with agarose gel electrophoresis, to appreciate the presence of other proteins in the cryoprecipitate, offers a more sensitive and specific tool for confirming the diagnosis of cryoglobulinemia. Using such strategy, we established reference values for immunoglobulins in cryoprecipitate in diseased controls and applied them to 214 consecutive patients.

Involuntary weight loss. Does a negative baseline evaluation provide adequate reassurance?

Background: Involuntary weight loss frequently poses a diagnostic challenge. Patient and physician alike want to exclude malignant and other major organic illness. The present study aimed to evaluate whether a negative baseline evaluation (consisting of clinical examination, standard laboratory examination, chest X-ray, and abdominal ultrasound) lowers the probability of evolving organic illness in patients with significant unexplained weight loss.

Sequential therapy with cefuroxime and cefuroxime-axetil for community-acquired lower respiratory tract infection in the oldest old.

Background And Aims: Community acquired lower respiratory tract infection (CALRTI) is the most common infection requiring hospitalization in the elderly. Sequential antibiotic therapy offers the potential for earlier functional rehabilitation, shorter length of hospital stay and lower costs. We studied the efficacy and safety of an empiric sequential antibiotic therapy with cefuroxime-cefuroxime axetil in elderly patients hospitalized with a CALRTI.

Recurrent fevers of unknown origin.

Recurrent fever of unknown origin is mostly caused by rather rare diseases and many cases remain unexplained. The very limited literature data do not allow one to construct a diagnostic algorithm. A number of general principles should be kept in mind before starting the investigation for this rare subtype of fever of unknown origin.

Retropharyngeal calcific tendonitis.

Calcific tendonitis of the longus colli muscle is an uncommon cause of sudden onset of neck pain. Differential diagnosis should include retropharyngeal abscess, traumatic injury or even meningitis. Diagnosis can be made radiographically with plain radiograph which reveals an amorphous calcification anteriorly to C1-C2 and severe swelling of the prevertebral soft tissue.

Intravascular large B-cell lymphoma of the uterus presenting as fever of unknown origin (FUO) and revealed by FDG-PET.

Non-Hodgkin's lymphoma (NHL) is a common cause of Fever of Unknown Origin (FUO) but the presentation as a gynaecologic malignancy is exceedingly rare. To our knowledge, this represents the first report of an intravascular large B-cell lymphoma of the uterus presenting with fever of unknown origin. After a standard clinical work-up for FUO, the endometrial curettage directed by the finding of a localized fluoro-deoxyglucose Positron Emission Tomography (FDG-PET) hot spot in the pelvic area, yielded material revealing an intr avascular B-cell lymphoma.

Cardiac involvement in systemic inflammatory diseases.

Systemic inflammatory diseases represent a large group of rare diseases that may involve all organs and also the heart. The three layers of the heart can be affected and some manifestations such as pericarditis in systemic lupus erythematosus are rather well known, yet others are not known even for cardiologists. Modern sophisticated imaging techniques reveal cardiac abnormalities in most of these diseases and the reported frequency of cardiac involvement ranges widely depending upon the applied diagnostic methods and selection of patients.