No abstract

A cerebrospinal fluid (CSF) pseudocyst can rarely occur in the breast. It usually results from damage to a ventriculoperitoneal (VP) shunt during a mammogram or augmentation breast surgery. If fluid collection is seen in close proximity to the VP shunt, it should raise the suspicion of a CSF pseudocyst.

The leukoencephalopathies with cystic changes form a distinct subtype of childhood onset neurodegenerativedisorders. This group has heterogeneous etiological differentials that primarily include mitochondrial disorders, some leukodystrophies and central nervous system infections. We report this case of a 17-month old girl who presented with seizures, episodic encephalopathy, elevated blood lactate level and lactate peak on magnetic resonance spectroscopy, a typical imaging picture noted on cranial magnetic resonance imaging and absence of deletions or duplications of mitochondrial deoxyribonucleic acid. Progressive cavitating leukoencephalopathy (PCL) is a recently described entity with only a few cases reported so far. We report the first case of PCL from India. Accurate diagnosis can be made, not only, by the presence of typical clinicoradiological findings of PCL, but also by the awareness of, and, ruling out of, the various other differential diagnoses that are discussed in detail below.

Introduction: The uninsured population presents unique challenges to the application of an integrated approach to population health. Our objective is to compare and test population risk indices for identifying a cohort of uninsured patients at high-risk for avoidable healthcare utilization and costs. Methods: Patients who had a least one visit at a safety-net clinic, had a primary address in Mecklenburg County, were aged 18-74, and had the most recent healthcare visit coded as 'uninsured' were identified in the baseline period. The five risk indices used were: the HHS Hierarchical Conditions Category (HCC), the Charlson Comorbidity Index (CCI), Total Cost Index, Total Inpatient Visits Index, and Total Emergency Department Visits Index. First, agreement across the five indices was analyzed. Then, the accuracy of the five risk indices was tested in predicting future utilization and costs for the subsequent 12-month follow-up period. Results: Kappa statistics and percent overlap values showed below average to poor agreement between indices when comparing scorers. The strongest predictors of being in the 90 th percentile of total cost during the 12 months follow-up period were the Total Cost Index at baseline (C statistic=0.75) and the HCC (C-statistic=0.73). The CCI and Total Inpatient Visit Index's demonstrated the lowest accuracy for predicting an unnecessary ED visit (C-statistic=0.51, for both) Discussion/Conclusion: Prior cost and ED utilization were key in predicting their corresponding 12-month metrics. In contrast, the Total Inpatient Visit Index had the worst predictive performance for future hospitalization rates. Some indices were similarly predictive as compared to insured cohorts but others showed contrasting results.