Clinical Images: iliopsoas bursa rupture mimicking psoas muscle abscess.
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ABSTRACT: Iliopsoas abscesses (IPAs) are rare infections involving purulence within the muscles of the iliopsoas compartment, seldom due to Methicillin-resistant Staphylococcus aureus (MRSA) historically. This study was designed to evaluate the clinical characteristics and outcomes of patients with IPAs. A retrospective analysis of the demographics, clinical presentation, microbiologic data and treatment modalities among patients with IPAs from 1993 to 2007 at The Johns Hopkins Hospital was performed. Among 61 patients with IPAs, infection rates increased from 0.5 cases/10,000 admissions (1993-2004) to 6.5 cases/10,000 admissions (2005-2007) (P < 0.001). An adjacent infectious focus was identified in 80% of patients, from skeletal (48%), intra-abdominal (23%), vascular (5%), genitourinary (3%), and cutaneous sources (2%). During 2005-2007, MRSA became a predominant pathogen, accounting for 25% of all cases and 37% of cases with a definitive microbiologic diagnosis (P = 0.006). Patients with IPAs >2 cm were more likely to undergo drainage, with trends toward longer hospitalizations, longer antibiotic courses, and increased odds of securing a definitive microbiologic diagnosis. Since 2005, rates of IPA have dramatically increased, with MRSA now the leading cause of infection. Knowledge of common pathogens should guide antimicrobial therapy including empiric coverage for MRSA in institutions with similar populations, especially if culture data are not available.The Journal of infection 05/2011; 63(1):1-7. · 4.13 Impact Factor
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ABSTRACT: The present study aims to provide a comparative evaluation of the antitumor activity from Cordia verbenacea extracts obtained by supercritical fluid extraction (SFE) with CO2 at 300bar and 50°C and by classical organic solvent extraction (CE) with ethanol. Antitumor in vitro assays were performed for both extracts and the results demonstrate that the supercritical extract causes superior reduction in tumor cells viability and proliferation, whereas the most probable type of cell death is apoptosis. Only the extract obtained by SFE was able to reduce the expression of COX-2 in MCF-7 cells. The in vivo treatment using supercritical extract decreased the tumor volume, the body weight and packed cell volume, as well as increased in 25% the mean survival time, compared to negative control. As a conclusion, the high pressure extraction method enhanced the cytotoxicity and the antitumor activity of extract from C. verbenacea. Additionally, the antitumor mechanism was probably caused by the inhibition of COX-2, leading to the blockage of the survival cells by apoptosis induction.Journal of Supercritical Fluids The 01/2012; · 2.57 Impact Factor
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Clinical Images: Iliopsoas bursa rupture mimicking psoas muscle abscess
The patient, a 49-year-old woman with psoriatic arthritis treated with infliximab and methotrexate, was admitted to the hospital with
a 3-day history of sudden-onset right hip pain and fever up to 39°C with rigors. Magnetic resonance imaging (MRI) (left) and
computed tomography (CT) (right) revealed swelling in the right iliac, pectineal, and obturator muscles and probable fluid
collection in the right iliac muscle, consistent with intramuscular abscess. CT-guided percutaneous drainage yielded only 1 ml of
serous fluid; bacterial cultures, including studies for Mycobacterium, were negative. Further inquiry into the patient’s history
revealed that she often squatted while playing with children as a kindergarten teacher. Her symptoms improved upon treatment with
nonsteroidal antiinflammatory drugs (NSAIDs) alone, and she was discharged on the sixth hospital day with a diagnosis of iliopsoas
bursa rupture. She continued to receive infliximab and methotrexate along with NSAIDs. Followup MRI 2 months later showed
almost complete resolution.
Hiromichi Tamaki, MD
Mitsumasa Kishimoto, MD, PhD
Masato Okada, MD
St. Luke’s International Hospital
DECREASED RISK OF CANCER IN PATIENTS WITH GCA1769