No significant correlation was found between the molecular weight of the tested substances and the frequency of DTH reactions. In patients with DTH to enoxaparin, the LMWH bemiparin is not a suitable alternative.

BackgroundHeart Failure (HF) is a common reason for hospitalization. Admissions might be prevented by early detection of and intervention for decompensation. Conventionally, changes in weight, a possible measure of fluid accumulation, have been used to detect deterioration. Transthoracic impedance may be a more sensitive and accurate measure of fluid accumulation.ObjectiveIn this study, we review previously proposed predictive algorithms using body weight and noninvasive transthoracic bio-impedance (NITTI) to predict HF decompensations.MethodsWe monitored 91 patients with chronic HF for an average of 10 months using a weight scale and a wearable bio-impedance vest. Three algorithms were tested using either simple rule-of-thumb differences (RoT), moving averages (MACD), or cumulative sums (CUSUM).ResultsAlgorithms using NITTI in the 2 weeks preceding decompensation predicted events (P<.001); however, using weight alone did not. Cross-validation showed that NITTI improved sensitivity of all algorithms tested and that trend algorithms provided the best performance for either measurement (Weight-MACD: 33%, NITTI-CUSUM: 60%) in contrast to the simpler rules-of-thumb (Weight-RoT: 20%, NITTI-RoT: 33%) as proposed in HF guidelines.ConclusionsNITTI measurements decrease before decompensations, and combined with trend algorithms, improve the detection of HF decompensation over current guideline rules; however, many alerts are not associated with clinically overt decompensation.

SUMMARY:Early diagnosis and prompt initiation of adequate treatment are essential for clinical outcome in ISCA. We report a case in which DWI provided a more specific diagnosis than conventional MR imaging and allowed differentiation of a ring-enhancing lesion from intramedullary tumor. Diagnosis was proved by PCR from CSF (Streptococcus intermedius). Adequate antibiotic treatment was immediately initiated, and the patient recovered completely.ABBREVIATIONS: ADC ϭ apparent diffusion coefficient; DWI ϭ diffusion-weighted imaging; Gd ϭ gadolinium; ISCA ϭ intramedullary spinal cord abscess; PCR ϭ polymerase chain reaction I SCA is a rare entity that was first described by Hart in 1830, 1 and until now, to our knowledge, Ͻ100 cases have been reported in the literature. The early clinical suspicion and radiologic diagnosis are mandatory to start appropriate medical or surgical treatment and to avoid irreversible spinal cord damage. The radiologic technique of first choice is unambiguously MR imaging with intravenous Gd-chelates application, but differentiation from intramedullary tumors may be difficult. Case ReportA 80-year-old female patient with diabetes mellitus had been admitted with thoracic back pain after a collapse 2 days before. Other complaints were weakness in both legs, headache, and urinary incontinence.The clinical examination revealed slightly elevated body temperature (37.8°C), local tenderness along the thoracic spine, monoparesis, and hypoesthesia of the left leg below the T7 level and a positive Babinski sign on the left side. Blood tests at admission showed the following values: increased leukocytes of 16,700/L, an erythrocyte sedimentation rate of 16 mm/h, and moderately elevated C-reactive protein (69.5 mg/L). Findings of repeated blood and urine cultures were negative.Unremarkable conventional radiographs of the thoracic spine were followed by conventional MR imaging (including intravenous Gd-chelates application), which did not show any signs of contusion or fracture in the thoracic vertical bodies but did show an edema of the spinal cord extending from level T4 to T12 and a focal ring-enhancing lesion on level T8 with central necrosis and a diameter of 2 cm ( Fig 1A, -B). On T2-weighted images, the hypointense rim of the lesion could be delineated (Fig 1B). To differentiate an abscess from a tumor, we performed additional DWI with an axial and sagittal single-shot echo-planar spin-echo sequence. The images were acquired with b-values of 0 and 1000 s/mm 2 . The cavity of the lesion appeared strongly hyperintense on DWI and showed low ADCs on the ADC map compared with the myelon above and below the lesion, suggesting an intraspinal abscess (Fig 1C, -D). Lumbar puncture yielded the following values: white blood cells, 466/L; protein, 800 mg/L; and lactate, 4.7 mmol/L. CSF microscopy found predominantly polynuclear white blood cells but no tumor cells. Results of CSF Gram stain and culture were negative. PCR from CSF yielded deoxyribonucleic acid of Streptococcus intermedius. Therapy was initiat...

This series confirms PX as a rare, but distinguished clinicopathologic entity in the spectrum of n-LCH of the skin.

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