BACKGROUND: Blood cultures are often obtained in children hospitalized with skin and soft tissue infections (SSTIs). Because little evidence exists to validate this practice, we examined the yield of blood cultures in the evaluation of immunocompetent children with SSTIs. METHODS: Medical records were reviewed for all children admitted between January 1, 2007 and December 31, 2009 after emergency department evaluation and diagnosis of cellulitis or abscess. We compared patients with SSTIs (n = 482) with those with complicated SSTIs (cSSTIs; n = 98). A cSSTI was defined as surgical or traumatic wound infection, need for surgical intervention, or infected ulcers or burns. The SSTI group included patients without complicating factors. RESULTS: None of the patients in the SSTI group had a positive blood culture. In the cSSTI group, 12.5% of blood cultures were positive. The mean length of hospital stay (LOHS) of children with SSTIs was shorter than that of those with cSSTIs (P < .001). In the SSTI group, obtaining a blood culture was associated with a higher mean LOHS (P = .044). CONCLUSIONS: Blood cultures are not useful in evaluating immunocompetent children who are admitted to the hospital with uncomplicated SSTIs, and they are associated with a nearly 1-day increase in mean LOHS.

Purpose: Nodular heterotopia (NH) is a common cause of drugresistant epilepsy. Only limited studies detail the treatment of NH with laser interstitial thermal therapy and none analyze the relation between epileptogenicity and NH location.Methods: We retrospectively studied nine patients with drugresistant epilepsy and NH who underwent stereoelectroencephalography and subsequent epilepsy surgery. Nodular heterotopia in the frontal lobes or along the bodies of the lateral ventricles was classified as anterior NH. Nodular heterotopia in the trigones, temporal or occipital horns, or temporal lobes was classified as posterior NH. Nodular heterotopia in both anterior and posterior locations was classified as diffuse NH. Interictal and ictal stereoelectroencephalography were analyzed, and patients were followed postoperatively to assess outcomes.Results: Of the six patients who underwent nine laser interstitial thermal therapy procedures either in isolation or in combination with other surgical therapies, four patients were Engel Ia, one was Engel IIb, and one was Engel IIIa, with an average follow-up of 22.8 months. All patients with posterior NH had interictal epileptiform abnormalities and seizures originating from the posterior NH. None of the patients with anterior NH had epileptiform activity recorded from their NH. Conclusion:Laser interstitial thermal therapy alone or in combination with other surgical therapies is an effective treatment in those with drug-resistant epilepsy because of NH, even in those with extensive NH and broad seizure onset. We observed a trend suggesting that posterior NH are more likely to be epileptogenic compared with anterior NH and recommend that in patients with anterior NH, alternative epilepsy etiologies and stereoelectroencephalography implantation strategies be considered.

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ObjectiveTo describe a case of sarcoma associated with NMOSD presenting with myeloradiculitis.BackgroundNeuromyelitis optica is a demyelinating disease of the CNS that predominantly affects the spinal cord and optic nerves. Reports of NMOSD occurring in the setting of cancer suggest that aquaporin-4 autoimmunity may have a paraneoplastic basis. Here, we describe a patient with metastatic sarcoma who tested positive for aquaporin-4 IgG consistent with NMOSD.Design/Methods66-year-old man with left thigh soft tissue sarcoma with metastasis to the lungs admitted for 2-day history of urinary retention. Neurological exam showed bilateral lower extremity weakness, with decreased patellar reflexes. MRI spine showed cord swelling with enhancement from C6 downwards into the thoracic spine with associated syringohydromyelia and diffuse enhancement of the cauda equina. MRI brain was normal without abnormal enhancement in the optic nerves. CSF analysis demonstrated elevated protein and 0 oligoclonal bands. Was started on methylprednisolone 1 gram daily for 5 days empirically for transverse myelitis. Extensive serum and CSF workup for other causes of myelopathy including rheumatologic, infectious, and nutritional etiologies were unremarkable until NMO IgG antibody came back positive at 1:10000 titer. He had minimal clinical improvement after methylprednisolone course and so was started on plasmapheresis for five days. His weakness improved slightly but continued to have urinary retention. Discharged to a long-term acute care facility on prednisone 60 mg daily with intermittent bladder catheterization and plan for follow-up with Neuroimmunology.ResultsNA.ConclusionsMyeloradiculitis has been reported with anti-MOG disease but is not a typical finding for NMO. We report this case to highlight this unusual finding. In addition, sarcoma is an uncommon cause of paraneoplastic syndromes and to our knowledge, this is the first report of sarcoma being associated with paraneoplastic NMOSD.