We present a case of superficial thrombophlebitis of the arm, known as a variant of Mondor’s disease. A 71-year-old woman who underwent a left simple mastectomy with axillary dissection for breast cancer had a cord-like vein structure in the right antecubitalfossa following postoperative intravenous chemotherapy, and complained of limited elbow extension due to the firm and inflexible structure. She successfully underwent surgical resection of the vein cord to relieve the elbow motion limitation.
INTRODUCTION: There are various anaesthetic techniques for ambulatory surgery of carpal tunnel release. The ultrasound-guided nerve blocks offer advantages compared to other techniques. The purpose of this study was to evaluate the efficacy using ultrasound-guided block at the antecubitalfossa, as well as to evaluate complications, patient satisfaction and surgeon satisfaction with the block. MATERIALS AND METHODS: Prospective observational study with 32 elective patients for carpal tunnel release in a one-day case unit. An ultrasound-guided block with mepivacaine 1% was performed at the antecubitalfossa, aiming for the median, ulnar and the lateral and medial cutaneous nerves of the forearm. The measurements of the anteroposterior and laterolateral diameters of the median and ulnar nerves were recorded, before and after injection. Motor and sensory levels were evaluated for the median and ulnar nerves at 5 and 30min post injection, and compared with the contralateral hand. Pain from the surgical incision time and recovery were recorded, together with complications, and patient and surgeon satisfaction with the block. RESULTS: The antecubitalfossa ultrasound-guided block was successful in 93.7% of the patients. No patients needed rescue analgesia in recovery and no complications were recorded. Patient satisfaction was 93.7% and surgeon satisfaction was 97%. CONCLUSIONS: A selective block of the medial, ulnar and medial and lateral cutaneous nerves of the forearm are effective and satisfactory anaesthetic techniques for carpal tunnel release in a one-day case unit. It allows early mobilization, minimises risks and amount of local anaesthetic used. PMID:23177531
The creation of buttonhole tracks with Supercath Safety Clampcath is a novel and simple technique that allows dull fistula needle insertions with relative ease and diminished pain. As greater experience with this procedure develops, new issues arise for consideration. We report an unexpected complication of Supercath Safety Clampcath catheter breakage that may be due to physical distortions as a result of its location in the antecubitalfossa just proximal to the elbow joint. We present a review of our experience and a framework for the safe ongoing use of this device for creation of buttonholes in fistula for hemodialysis. PMID:22925205
The purpose of this study is to report the results of a single limited-incision technique for repair of acute distal biceps ruptures by use of suture anchors. Sixty consecutive patients underwent distal biceps repair after an acute rupture between January 1997 and January 2001 by use of a limited antecubital incision and suture anchors. Fifty-three patients could be evaluated at a mean follow-up of 38.1 months. A limited transverse incision was made in the antecubitalfossa. The retracted biceps tendon end was identified, retrieved, and lightly debrided. Two suture anchors were placed in the radial tuberosity, and the tendon was reapproximated. Final follow-up consisted of physical examination, radiographs, and Andrews-Carson elbow score tabulations. According to the Andrews-Carson scores, there were 46 excellent and 7 good results. In 2 patients, heterotopic ossification developed that resulted in a mild loss of forearm rotation and mild pain. In 1 patient, a temporary radial nerve palsy developed, which resolved completely within 8 weeks. Repair of acute distal biceps tears via a limited antecubital incision and suture anchors is a safe, effective technique. PMID:16963286
Long term D-penicillamine (DPA) therapy to treat Wilson disease can induce elastosis perforans serpiginosa (EPS), a very rare degenerative skin disease characterized by a transepidermal elimination of elastic fiber aggregates. The iatrogenous disease depends on DPA capacity to chelate copper and cause its depletion. Lysyl-oxidase is a copper dependent enzyme crucial to the dermal elastic fiber cross-linking, which is strongly affected by DPA copper depletion. Direct binding of the drug to collagen precursors also affects elastic fiber assemblage and maturation. The abnormal elastin accumulates into the middle dermis and produces a characteristic bramble brush or "lumpy-bumpy" appearance. In this way it acts as a foreign body and is progressively extruded through the epidermis. Clinically, the disease presents with multiple firm keratotic papules and nodules arranged in annular plaques over the neck, axillae, antecubitalfossae, and forearms. The rarity of the disease frequently causes misdiagnoses and the process continues unabated causing concerns about systemic elastopathy. PMID:21549078
This is the second in a series of papers related to procedure-oriented joint anatomy. This article will review the anatomy of the elbow and its relationship to procedures in the clinical setting. Needle procedures of the elbow joint include medial and lateral epicondyle injections, olecranon bursa injection, elbow joint aspiration, phlebotomies in the antecubitalfossa, and intramuscular injections such as trigger point and botulinum toxin injections. Complications related to these procedures include infection, skin atrophy, injuries to peripheral nerves, tendon rupture associated with the use of corticosteroids, iatrogenic vascular injuries, and chronic local pain. This article provides anatomically accurate schematics of the elbow anatomy relevant to needle procedures. Cross-sectional anatomical schematics of the elbow were drawn as they appear on axial and coronal projections. Superficial and deep landmarks are highlighted as well as sources of potential complications. These schematics allow for safer and more accurate needle procedures in the elbow area, for both nonguided and musculoskeletal ultrasound-guided techniques. PMID:22261788
Late-onset focal dermal elastosis is a rare disorder that presents clinically with the development of small white-to-yellow papules simulating pseudoxanthoma elasticum (PXE) in otherwise healthy adults in the seventh through ninth decades. It is characterized histopathologically by foci of increased normal-appearing elastic tissue in the reticular dermis. The disorder lacks any of the systemic complications of PXE and clinically resembles several other elastic tissue disorders that mimic PXE. We report two cases of late-onset focal dermal elastosis. The first is of a 75-year-old female who presented with symmetrically distributed, 2-5 mm white-to-yellow, discrete and coalescing, non-follicular papules on the posterolateral neck, anterior chest and axillae. The second case involves a 39-year-old female who presented with asymptomatic flesh-colored lesions on the posterior neck, back, antecubital and popliteal fossae, thighs, forearms and wrists. Skin biopsies in each case revealed aggregates of elastic fibers in the reticular dermis without calcification. The differential diagnosis of clinical and histopathologic imitators of PXE is discussed. PMID:22882354
ABSTRACT: BACKGROUND: Characterization of the topographical and temporal diversity of the microbial collective (microbiome) hosted by healthy human skin established a reference for studying disease-causing microbiomes. Physiologic changes occur in the skin as humans mature from infancy to adulthood. Thus, characterizations of adult microbiomes might have limitations when considering pediatric disorders such as atopic dermatitis (AD) or issues such as sites of microbial carriage. The objective of this study was to determine if microbial communities at several body sites in children differed significantly from adults. METHODS: Using 16S-rRNA gene sequencing technology, we characterized and compared the bacterial communities of four body sites in relation to Tanner stage of human development. Body sites sampled included skin sites characteristically involved in AD (antecubital/popliteal fossae), a control skin site (volar forearm), and the nares. Twenty-eight healthy individuals ranging from 2-40 years old were evaluated at the outpatient dermatology clinic in the National Institutes of Health's Clinical Center. Exclusion criteria included the use of systemic antibiotics within 6 months, current/prior chronic skin disorders, asthma, allergic rhinitis, or other chronic medical conditions. RESULTS: Bacterial communities in the nares of children (Tanner developmental stage 1) differed strikingly from adults (Tanner developmental stage 5). Firmicutes (Streptococcaceae), Bacteroidetes, and Proteobacteria (beta, gamma) were overrepresented in Tanner 1 individuals as compared to Tanner 5, where Corynebacteriaceae and - 3 - Propionibacteriaceae predominated. While bacterial communities were significantly different between the two groups in all sites, the most marked microbial shifts were observed in the nares, a site that can harbor pathogenic species including Staphylococcus aureus and Streptococcus pneumonia. CONCLUSIONS: Significant shifts in the microbiota associated with progressive sexual maturation as measured by Tanner staging suggest that puberty-dependent shifts in the skin and nares microbiomes may have significant implications regarding prevention and treatment of pediatric disorders involving microbial pathogens and colonization. PMID:23050952
BACKGROUND: There is a negative glucose gradient between the capillary and venous systems, produced by glucose uptake into peripheral tissues. This gradient is augmented by oral glucose ingestion in healthy volunteers; thus prandial status may impact on capillary glucose meter performance. Our primary aim was to investigate whether the (capillary-venous plasma) glucose difference changed in relation to prandial status, in healthy volunteers. METHODS: Glucose was measured fasting and also one hour after an ad libitum breakfast, in 103 healthy volunteers. Duplicate capillary (finger stick) measurements were undertaken at both time points, using both the FreeStyle Lite and AccuChek Performa meters. Simultaneous venous (antecubitalfossa) samples were centrifuged immediately after collection and plasma glucose was measured using the laboratory hexokinase method. Results were compared by Bland-Altman difference analysis. RESULTS: The mean (95% CI) pre- and postprandial (capillary-plasma) glucose differences (mmol/L) were calculated for each meter. For the Freestyle Lite, the preprandial difference was -0.51 (-0.58 to -0.45) and postprandial difference was 0.81 (0.69-0.94). Corresponding differences for the Performa were -0.13 (-0.20 to -0.06) and 1.19 (1.07-1.31), respectively. T-test comparison of participants' paired pre- and postprandial (capillary-plasma) glucose differences confirmed a significant meal-related change in glucose estimation for both meters (P < 0.0001). Also, both meters read highest at lower glucose concentrations. CONCLUSIONS: In healthy volunteers, both glucose meters showed a systematic positive bias one hour after breakfast. The significance of this finding in diabetes remains to be determined. PMID:23148281
... rash and rashes clinical tools newsletter | contact Share | Drug Eruption, Unclassified (Pediatric) A parent's guide to condition ... lesions coming together into larger lesions typical of drug rashes (eruptions). Overview A drug eruption, also known ...
Understanding embryologic development of the cerebellum and the 4th ventricle is essential for understanding posterior fossa malformations. Posterior fossa malformations can be conveniently classified into those that have a large posterior fossa and those with normal or small posterior fossa. Disorders associated with a large posterior fossa include classic Dandy–Walker malformation, Blake's pouch cyst, mega cisterna magna, and posterior fossa arachnoid cyst. Disorders associated with normal or small posterior fossa include Dandy–Walker variant, Joubert syndrome, tecto-cerebellar dysraphia, rhombencephalosynapsis, the neocerebellar hypoplasias, and cerebellar atrophy. Neuro-imaging features should enable the imager to provide the referring physician a logical approach to thes...
... answer discussion forum widgets for professionals dermatology education rash and rashes clinical tools newsletter | contact Share | Mohs Surgery A ... Top Rated Forum Topics undiagnosed skin condition 5 eczema I am in pain 4.57143 Getting rid ...
... may advance to more serious stages. A temporary rash develops at first, but eventually the heart and ... suck blood. The lice do not produce a rash, but scratching the skin constantly could cause irritation ...
... rash and rashes clinical tools newsletter | contact Share | Strawberry Hemangioma (Infantile Hemangioma) A parent's guide for infants and babies A A A Strawberry red hemangiomas grow rapidly, and particularly those near ...
... rash and rashes clinical tools newsletter | contact Share | Tick Bites, First Aid A A A It is ... after being outdoors in wooded or grassy areas. Ticks often hide in obscured areas, such as around ...
... rash and rashes clinical tools newsletter | contact Share | Herpes Simplex Virus (HSV) A parent's guide to condition and treatment information ... eruption of skin or mouth sores with the herpes simplex virus (HSV) is called primary herpes. This may ...
... rash and rashes clinical tools newsletter | contact Share | Herpes Simplex Virus (HSV) A parent's guide for infants and babies A ... within an inflamed area of skin typical of herpes simplex. Overview Herpes infections are caused by both herpes ...
... search trusted links explore resource centers health articles health topics community skinmatters blog question & answer discussion forum widgets for professionals dermatology education rash and rashes clinical tools newsletter | contact Share | ...
... Tub Rash” and “Swimmer’s Ear” (Pseudomonas) What is Pseudomonas and how can it affect me? Pseudomonas (sue- ... a health care provider for treatment. How is Pseudomonas spread? Hot tub rash can occur if contaminated ...
... clinical tools newsletter | contact Share | Hot Tub Rash ( Pseudomonas Folliculitis) Information for adults A A A This ... small pus-filled lesions. Overview Hot tub rash ( Pseudomonas folliculitis) is an infection of the hair follicle ...
... rash and rashes clinical tools newsletter | contact Share | Contact Lens Solution Toxicity Information for adults A A A This image shows a reaction to contact lens solution. The prominent blood vessels and redness over ...
... rashes clinical tools newsletter | contact Share | Jellyfish Stings, First Aid A A A The rash caused by a ... to Portuguese man-of-war stings as well. First Aid Guide The rescuer should take care to avoid ...
... that mainly affects the skin. A red, raised rash may appear on the face, scalp, or elsewhere. The rash may last for days or years and may ... or swollen joints called arthritis • inexplicable fever • skin rashes • kidney problems This document is a summary of ...
... be severe enough to require pain medication. Some patients, however, do not experience that excruciating pain. A few days after the pain starts, a red rash appears at the site of the nerve. Fever or headache may accompany the rash. The rash turns into ...
Abstract We report on the case of a 2-year-old girl recently diagnosed with Methylenetetrahydrofolate reductase (MTHFR) deficiency who originally presented in the neonatal period with a distinctive rash. At 11 weeks of age she developed seizures, she had acquired microcephaly and developmental delay. The rash deteriorated dramatically following commencement of phenobarbitone; both rash and seizures abated following empiric introduction of pyridoxine and folinic acid as treatment of possible vitamin responsive seizures. We postulate that phenobarbitone in combination with MTHFR deficiency may have caused her rash to deteriorate and subsequent folinic acid was helpful in treating the rash and preventing further acute neurological decline as commonly associated with this condition. 2012 Wiley...
Eighteen patients with adult-onset Still's disease have been followed up for 3-22?years in our department. Initial manifestations were fever with skin rash in 14 patients, fever, skin rash and sore throat in two, skin rash in one and arthralgia in one. During the follow-up period, typical skin rash was seen in all patients, of them five patients (29%) revealed atypical skin rash simultaneously. Atypical rash included persistent erythema with pigmentation in two, persistent plaques and papules with linear erythema in two and edema of the eyelids mimicking dermatomyositis in one. Persistent papules and plaques revealed histologically characteristic features, such as dyskeratotic keratinocyte and liquefaction degeneration as well as a sparse superficial dermal infiltrate containing scattered neutrophils. In patients of chronic articular type and polycyclic systemic type, atypical skin rash, lymphadenopathy and hyperferritinemia were noted to be significantly higher than those of monocyclic type. These factors might be prognostic factors of adult-onset Still's disease in our study. PMID:22734944
Calcification is exceedingly rare in schwannomas. In the literatures, we found only three reports of schwannomas with calcification. We report two cases of intracranial calcified schwannomas, one in the anterior cranial fossa and the other in the middle cranial fossa.
Posterior fossa syndrome is characterized by cerebellar dysfunction, oromotor/oculomotor apraxia, emotional lability and mutism in patients after infratentorial injury. The underlying neuroanatomical substrates of posterior fossa syndrome are unknown, but dentatothalamocortical tracts have been impl...
Cerebellar mutism, also known as 'posterior fossa syndrome,' is an uncommon condition often reported after posterior fossa tumour resection in the paediatric population. It is infrequently associated with other intrinsic cerebellar pathologies. We hereby report a rare case of pre-operative cerebellar mutism associated with an extrinsic posterior fossa lesion - vagus nerve schwannoma. PMID:22111953
Cerebellar mutism, also known as `posterior fossa syndrome,' is an uncommon condition often reported after posterior fossa tumour resection in the paediatric population. It is infrequently associated with other intrinsic cerebellar pathologies. We hereby report a rare case of pre-operative cerebellar mutism associated with an extrinsic posterior fossa lesion - vagus nerve schwannoma.
Abstract Eighteen patients with adult-onset Still-s disease have been followed up for 3-22-years in our department. Initial manifestations were fever with skin rash in 14 patients, fever, skin rash and sore throat in two, skin rash in one and arthralgia in one. During the follow-up period, typical skin rash was seen in all patients, of them five patients (29%) revealed atypical skin rash simultaneously. Atypical rash included persistent erythema with pigmentation in two, persistent plaques and papules with linear erythema in two and edema of the eyelids mimicking dermatomyositis in one. Persistent papules and plaques revealed histologically characteristic features, such as dyskeratotic keratinocyte and liquefaction degeneration as well as a sparse superficial dermal infiltrate containing s...
The antecubital flap is a fasciocutaneous strip that has its blood supply provided by the first proximal collateral of the radial artery. This flap was described for the first time in 1983 by Lamberty and Cormack, but it has not been widely used and there have been only a few reports in the literature concerning this procedure. The aim of the present investigation was to demonstrate via an anatomical study and a report on five cases the viability of the various anatomical features of this cutaneous flap, and also its positive contribution to elbow reconstruction. The anatomical study involved eight fresh cadavers (eight upper limbs). An injection of colored prevulcanized latex was made in the humeral artery in the lower third of the arm. The aim was to determine which artery provided blood supply to the flap, its anatomical location, and also to look for possible distal anastomoses which would permit a distal pedicled flap to be removed. Contrary to the findings of other authors, in the present study it was found that the vessel providing blood to the antecubital flap always branched off from the radial artery. However, no anastomoses with distal vascularization were detected, which would have permitted a distal pedicled flap to be obtained. The use of the antecubital flap for elbow coverage was then illustrated by five clinical cases of soft tissue defects of the elbow. This method was found to be reliable, practical, and the flap could be rapidly dissected. Moreover, this particular technique is sensitive, and has an interesting rotational arc. The distal cutaneous island flap has the advantage of limiting scar tissue. A comparison between the antecubital flap and other pedicled flaps has then been made. In conclusion, it appears that this little-known procedure has definite advantages, and that it should be included in the range of surgical techniques that are available for soft tissue reconstruction in the case of elbow defects. PMID:11233730
Encephalitis associated with varicella-zoster virus (VZV), rare among children in the varicella vaccine era, has generally been associated with a rash. We report fatal wild-type VZV encephalitis without a rash in a child who had received 1 dose of varicella vaccine. VZV encephalitis should be considered in the differential diagnosis for children presenting with acute neurologic symptoms, even vaccine recipients. PMID:22982982
We report a case of pulmonary fibrosis in a 32-year-old man, who had worked at a steel mill and who died of respiratory failure due to interstitial fibrosis despite vigorous treatment. He showed SLE-associated symptoms, such as pleural effusion, malar rashes, discoid rashes, arthritis, leukopenia, a...
Several pediatricians in one community began instructing mothers of infants with ammoniacal diaper rash to use o-benzyl-p-chlorophenol (OBPC) in laundering diapers. This simple, previously reported item of management was prescribed in 87 cases of ammoniacal rash. In almost all uncomplicated cases th...
A 28-year-old veteran presented to the Wilford Hall dermatology clinic in San Antonio, Texas, with a six-month history of a rash that his primary care physician diagnosed as molluscum contagiosum. The rash consisted of clusters of 3 to 6mm yellowish papules with erythematous borders that concentrate...
Erlotinib is an epidermal growth factor receptor tyrosine kinase inhibitor used in treatment of advanced NSCLC. Patients harboring EGFR or KRAS mutations represent minority of all patients in caucasian population and there is no available predictor for a?predominant group of patients harboring the wild-type EGFR and wild-type KRAS genes. Skin rash is the most frequent manifestation of cutaneous toxicity of erlotinib. Rash is associated with a?good therapeutic response. We aimed at the evaluation of rash as a?predictor of therapeutic effect of erlotinib in patients harboring the wild-type EGFR and KRAS wild-type genes and to assess its possible usage in a?clinical practice.Totally 184 patients with advanced stage NSCLC (IIIB, IV) harboring the wild-type EGFR and wild-type KRAS genes were analysed. Comparison of ORR, PFS and OS according to the occurrence of rash was performed. In order to assess the impact of rash in clinical practice it was conducted landmark analysis of the group of patients whose rash was observed during first month of treatment (n=124). Patients in whom progression was observed during the first month of treatment were excluded from the landmark analysis. The comparison of ORR was performed using Fisher's exact test, visualization of survival was performed using Kaplan-Meier survival curves and the differences in survival were tested using the log-rank test. Median PFS in patients who were observed with rash during the treatment was 3.0 vs. 1.2 months in patients with no rash (p<0.001), median of OS in patients who were observed with rash during the treatment was 13.9 vs. 5.8 months in patients with no rash (p<0.001). ORR in patients who were observed with rash during the treatment was 17.4% vs. 3.3% in patients with no rash (p=0.001). Median of PFS after 1 month of treatment in patients who were observed with rash during the first month was 2.9 vs. 1.1 months in patients with no rash (p=0.027). Median of OS after 1 month of treatment in patients who were observed with rash during the first month was 13.8 vs. 9.9 months in patients with no rash (p=0.082). Rash is strongly associated with better survival and ORR in patients harboring wild-type EGFR and wild-type KRAS genes. Occurrence of rash during the first month of treatment is a?useful predictor of better effect of erlotinib after one month of treatment. Patients who were not observed with rash during the first month of treatment are in high risk of progression. Optimization of the treatment of these patients can contribute restaging after two months of treatment, assessment of plasma levels of erlotinib and eventually attempt to dose escalation. Keywords: erlotinib, NSCLC, rash, targeted traetment, skin toxicity. PMID:23067213
The intercondylar fossa (ICF) indices can be used to evaluate fossa geometry, which may in turn affect the function, pathology and intracapsular surgical repair of the cranial cruciate ligament. The measurements of digital images of the distal femur of 44 dogs were used to calculate the fossa width, shape, height and area indices. The mean values of fossa width index were found to be 0.19, 0.28 and 0.37 at the cranial, central, and caudal levels of the fossa, respectively. The mean values for fossa shape, height and area indices were found to be 0.71, 0.33, and 0.16, respectively. The differences in ICF indices between male and female dog were not significant. Therefore, it is suggested that gender differences related to ICF geometry may not have any effect on incidence of cranial cruciate ligament injury in dogs. PMID:21327292
Posterior fossa syndrome can occur after neurosurgical resections of childhood posterior fossa tumors, such as medulloblastomas. Posterior fossa syndrome is characterized by transient mutism, emotional lability, cognitive deficits, weakness, ataxia, and cranial nerve dysfunction. Symptoms generally appear 1 to 3 days after surgery and persist for months to years. Neuroscience nurses play an integral role in helping affected children and their families through the diagnosis, treatment, and sequelae of this frightening syndrome. PMID:21796045
The objective of this study was to evaluate the effect of cooling the tonsillar fossa during thermal welding tonsillectomy on pain and wound healing. Prospective, blinded, clinical study was conducted. 30 patients who underwent tonsillectomy by thermal welding were evaluated. When one of the tonsillar fossa was cooled by isotonic fluid, the other has left untreated. Postoperative pain and mucosal healing pattern were assessed. Data were recorded and statistically analyzed. Healing process of the cooled down tonsillar fossae were significantly better on the 7th and 14th postoperative day (p welding tonsillectomy for cooling tonsillar fossae, accelerates wound-healing process significantly and decreases tonsillectomy related pain complaints post-operatively. PMID:22843096
Posterior fossa syndrome, characterized by oromotor or oculomotor apraxia, emotional lability, and mutism, occurs in some children after infratentorial tumor resection, and is thought to involve injury to the dentatothalamocortical tract. Previous cases of posterior fossa syndrome involved pediatric patients with cerebellar and other posterior fossa tumors. To heighten awareness that posterior fossa syndrome can occur after resections of tumors in other neuroanatomic locations, we present a 16-year-old boy who developed this syndrome after surgical removal of a supratentorial pinealoma, and we include a discussion of his self-reported signs. PMID:22115009
Abstract in spanish El rash es un efecto secundario común asociado al uso de fármacos antiepilépticos. La frecuencia de rash con fenitoína se ha estimado en un 5,9% y asciende a un 25% en pacientes que han presentado rash con otro fármaco antiepiléptico. La anemia aplásica es una anomalía adquirida de las células madre hematopoyéticas caracterizada por pancitopenia de la sangre periférica y médula ósea hipocelular. Los pacientes tratados con fenitoína presentan un riesgo 3,5 ve (more) ces mayor de desarrollar anemia aplásica. Presentamos el caso de una mujer de 70 años que desarrolló dos reacciones adversas severas y simultáneas a la fenitoína: un exantema maculopapular pruriginoso con compromiso de mucosas y una anemia aplásica. Ambas condiciones se resolvieron completamente con la suspensión del fármaco. Abstract in english Rash is a common side effect associated with antiepileptic drugs. The rate of a phenytoin rash is 5.9% and increases to 25% in those with another antiepileptic drug rash. Aplastic anemia is an adquired hematopoietic stem-cell disorder characterized by pancytopenia of the peripheral blood and hypocellular bone marrow. The use of phenytoin is associated with a 3.5 fold increased risk of aplastic anemia. We report a case of a 70-year-old woman who developed two severe advers (more) e reactions simultaneously with phenytoin: a maculopapular pruritic rash with involvement of mucous and an aplastic anemia. Both conditions normalized after phenytoin withdrawal.
The rasH2 mice are hemizygous transgenic mice carrying the human prototype c-Ha-ras gene with its own promoter region, and have been used in 6-month short-term carcinogenicity tests for pharmaceutical drugs in accordance with the recommendation of the International Conference on Harmonization of Technical Requirements of Pharmaceuticals for Human Use (ICH). Based on the validation studies, it has been recognized that they are very susceptible to genotoxic carcinogens. To elucidate the mechanism of the enhanced carcinogenesis, spontaneous and chemically induced tumors in rasH2 mice have been subjected to molecular analyses, but the results have thus far been equivocal. This article focuses on the possible molecular mechanism of enhanced carcinogenesis in rasH2 mice, based on the results of a search in the literature. In addition, there are several reports suggesting lesser carcinogenic susceptibility of rasH2 mice to some carcinogens: Malignant lymphomas were induced by treatment with phenolphthalein in heterozygous p53 knockout mice, but not in rasH2 mice, and ethinylestradiol, uterine tumor promoter, resulted in depression of uterine proliferative lesions in rasH2 mice. In this review, the possible mechanisms of why rasH2 mice were less sensitive for these carcinogens are also discussed.
Abstract in portuguese Rash cutâneo é um dos efeitos adversos mais comuns associados ao início de tratamento com lamotrigina, uma nova medicação antiepiléptica. Avaliamos se esse risco é maior em pacientes medicados concomitantemente com valproato em 103 pacientes adultos com epilepsia refratária, que tiveram lamotrigina adicionada a seu tratamento. Dez dos 33 pacientes (30%) que faziam uso de valproato e 6 (8%) dos 70 pacientes que não usaram valproato desenvolveram rash. Isto sugere (more) que existe maior risco de desenvolver rash cutâneo quando se adiciona lamotrigina em pacientes em uso de valproato (p Abstract in english Cutaneous rash is one of the commonest adverse events associated with lamotrigine. We assessed whether the risk is increased in patients receiving concomitant valproate therapy in a population of 103 adult patients with intractable epilepsy, who had lamotrigine added to their treatment. Of the 33 patients taking valproate, 10 (30%) developed a rash, whilst of the 70 not taking valproate, only 6 (8%) developed a rash. This suggests a significantly higher risk of cutaneous rash when starting lamotrigine in patients already taking valproate (p
Cognitive function has not been well studied after neurosurgery for posterior fossa lesions despite its potential importance in determining surgical indications and approaches. The present study evaluated changes in cognitive functions after posterior fossa surgery to detect any differences between the middle cranial fossa and lateral suboccipital approaches in 50 patients with posterior fossa lesions such as tumors and vascular diseases. Twenty-five patients underwent surgery via the middle fossa and 25 via the lateral suboccipital approaches. Computerized test battery (CogStateTM) and conventional neuropsychological tests (serial seven-word learning test and mini-mental state examination) were examined before, 1 month after, and 3 months after surgery. All scores of the neuropsychological tests remained within normal limits after surgery. However, the scores of one computerized test battery and serial seven-word learning tests decreased significantly 1 month after surgery and recovered within 3 months, indicating temporary deterioration of short-term memory in the middle fossa group. The computerized tests detected significantly larger numbers of patients with worsened results than the conventional tests. The middle fossa approach and operation time showed correlations with the postoperative neuropsychological declines. The computerized tests could be performed easily and were beneficial for detecting subtle changes of the cognitive function after surgery. Cognitive function, especially short-term memory, may decline temporarily with the middle fossa approach and long operation time.
PURPOSE: This study examined the usefulness of inflammatory markers in the management of patients with right iliac fossa pain. PATIENTS AND METHODS: A single site, prospective observational study was conducted from October 2001 to April 2003. Patients with right iliac fossa pain referred to the surg...
Three cases of intra-articular osteochondral bodies with the olecranon fossa are reported. All patients had had severe trauma to the elbow, and in each case an osteochondral fragment, nourished by the synovial fluid, became enlarged and finally lodged within the fossa. The radiological and pathological features and presumed pathogenesis are described.
In an ulna from an adolescent a fossa nudata divided the articular surface of the sigmoid notch into olecranon and coronoid areas. In the floor of the fossa a layer of loose avascular pannus covered a thin layer of articular cartilage. The pannus appeared to have been formed by removal of chondroiti...
... to the…to the implant or to the temporal fossa bone, in which case we typically will leave the ... this, again, this is the area of the temporal fossa and you can see this black marker area here, which is the approach where the dru…bone is drilled out to get to the nerve. ...
Two independent methods are presented for multidirectional CT scanning of the brain using the Philips Tomoscan 300. The advantages in scanning pituitary fossa tumours and pathology of the posterior fossa are discussed. No additional software or modifications are required. Direct sagittal scanning is particularly advantageous for accurate assessment of the size of pituitary tumours and intrasellar lesions requiring surgical intervention or radiation therapy.
In children medulloblastoma is a commonly encountered posterior fossa midline tumour in which cystic degeneration is not uncommon. A cystic medulloblastoma without solid component has, however, not been described. We report a 12-year-old boy with a posterior fossa midline cystic lesion on CT with surgical and histological confirmation of the diagnosis. (orig.).
... For example, radiation therapy might be used for cancers of the eyelid, tip of the nose, or ear. Several radiation treatments may be needed to destroy all the cancer cells. Radiation therapy may cause a rash or ...
... with a rash, swollen eyelids, or other grief. Painting Your Face: Special Effects Without Aftereffects Decorating your ... it says to remove it with soap and water, use soap and water. If it says to ...
... Atrovent); medications for irritable bowel disease, motion sickness, Parkinson's disease, or ulcers; other medications for urinary problems; ... body rash confusion hallucinations (seeing things or hearing voices that do not exist) anxiety restlessness coma (loss ...
... rashes clinical tools newsletter | contact Share | Jock Itch (Tinea Cruris) Information for adults A A A This image displays the fungal infection typical of tinea cruris ("jock itch"). Overview Jock itch (tinea cruris) is ...
... spotted fever Southern tick-associated rash illness Tick-borne relapsing fever Tularemia Other diseases that you can get from a tick in the United States include Colorado tick fever and Powassan encephalitis. Before You Go Outdoors Know where to expect ...
... a small rash on the back of my neck and the top of my left shoulder and ... not have complications almost everyone with shingles experiences pain. Stephen Straus, M.D.: Most individuals over age ...
... The cause of STARI is not known. Southern Tick-Associated Rash Illness (STARI) Symptoms, diagnosis, and treatment ... how they are different... Resources Additional information... General Tick Information Avoiding Ticks Avoid getting infected... Tick Lifecycle ...
... facial rash that resembles the wings of a butterfly unfolding across both cheeks — occurs in many but ... 2011. Haija AJ, et al. The role and effect of complementary and alternative medicine in systemic lupus ...
... and rashes clinical tools newsletter | contact Share | Flea Bite Information for adults A A A These bumps on the ankle were caused by flea bites. Overview Fleas are bloodsucking insects that live on ...
... and rashes clinical tools newsletter | contact Share | Bug Bite or Sting (Pediatric) A parent's guide to condition and treatment information A A A Insect bites or stings may be associated with large circular ...
... top commented | View forums what's new: skinmatters blog | skin of color resource center | skin care questions & answers | pregnancy skin ... and aging | skin cancer | skin rash and itch | skin of color | infant and child skin care research | explore | community | ...
... foods, soda, desserts, and junk foods CaLoriC iNtaKE CHart ACTIVITY LEVEL*FEMALESMALES Low 1800 calories 2200 calories ... caused by the varicella zoster virus that causes fever and an itchy rash that can cause: Skin ...
... and rashes clinical tools newsletter | contact Share | Mohs Surgery A A A Mohs Learning Series Mohs for ... huge concerns to patients who are facing cancer surgery on these areas. Fortunately, Mohs surgery – or simply “ ...
Fifty patients have been treated with clindamycin, a chemical analogue of lincomycin. Forty-four responded satisfactorily to treatment. Gastrointestinal side-effects were rare though five patients developed rashes. Most recently isolated staphylococci are clindamycin-sensitive.
A case of Lactobacillus rhamnosus-associated peritonitis in a patient undergoing continuous ambulatory peritoneal dialysis is reported. The patient was treated with vancomycin after isolation of glycopeptide-susceptible coagulase-negative staphylococci. After a skin rash developed, vancomycin was di...
presenting to the paediatric assessment unit of a district general hospital with fever and petechial rash, 9% had significant bacterial sepsis. The "ILL criteria" (irritability, lethargy, low capillary refill) for the management of children wit...
... the NHLBI on Twitter. What Is Thrombotic Thrombocytopenic Purpura? Thrombotic thrombocytopenic purpura (TTP) is a rare blood ... kee-ay). Petechiae may look like a rash. Purpura and Petechiae The photograph shows purpura (bruises) and ...
... disorder may experience rashes of tiny red spots (petechiae) caused by bleeding under the skin and blue ... do people use for ethylmalonic encephalopathy? EME Encephalopathy, petechiae, and ethylmalonic aciduria EPEMA syndrome For more information ...
... you have the flu Upset stomach Change in your sense of taste Back pain Skin rash Other Side Effects Lovaza may affect certain blood tests. Test to check your liver (ALT) Test to check your cholesterol (LDL- ...
... Eczema is an itchy rash also known as atopic dermatitis. Although atopic dermatitis is not necessarily caused by an allergic reaction, ... tissues and is one of the more common childhood cancers. Leukemia, which involves abnormal overgrowth of leukocytes, ...
... rashes clinical tools newsletter | contact Share | Recurrent Corneal Erosion Information for adults A A A The irregularity ... patient being the critical difference. Overview Recurrent corneal erosion is the recurrent breakdown of the outermost layer ( ...
Two Cents about Nickel Nickel is a leading cause of allergic contact dermatitis––an itchy rash that develops when a person’s skin touches a normally harmless material. Nickel is a silver-colored metal that is mixed ...
... and rashes clinical tools newsletter | contact Share | Sun Damage A A A The sun has a profound ... rough or scaly areas of skin due to damage from sun exposure. Some actinic keratoses can turn ...
... an unrelated donor. Transplanted cells attack the patient's tissue, causing a range of issues, from skin rashes and diarrhea to serious liver problems. Chronic GVHD typically occurs between three months ...
3.2.1 Two-Week Scheduling on a Weekly Cycle. ...... each generational cycle, to prepare a new generation, a pre- scribed process ...... and Machine Learning. ..... AUTHOR(S). 5d. PROJECT NUMBER. James L. Rash. 5e. TASK NUMBER. 5f.
...48 hours --Fever (>=100 [deg]F or 38 [deg]C) AND rash, glandular swelling, or jaundice --Diarrhea (>=3 stools in 24 hours or greater than normal amount) The 2003 Severe Acute Respiratory Syndrome (SARS) situation and concern...
...48 hours. --Fever (>=100 [deg]F or 38 [deg]C) AND rash, glandular swelling, or jaundice. --Diarrhea (>=3 stools in 24 hours or greater than normal amount). The 2003 SARS situation and concern about pandemic influenza and other...
... oily skin, infrequent shampooing, and alcohol-based lotions aggravate this harmless but bothersome condition. Other common causes of a rash include: Eczema (atopic dermatitis) -- tends to happen in people with ...
... cause some or all of the following symptoms: Abdominal pain Diarrhea Fever Headache Lack of appetite Muscle aches Nausea Rash Sore throat Swollen lymph nodes Vomiting These symptoms usually last for 3 - 6 ...
... affect many parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain. ... of lupus include • extreme fatigue • painful or swollen joints called arthritis • inexplicable fever • skin rashes • kidney problems ...
... parts of the body, including the joints, skin, kidneys, heart, lungs, blood vessels, and brain. When the ... swollen joints called arthritis • inexplicable fever • skin rashes • kidney problems This document is a summary of what ...
...proteins. The invention also describes DNA, viral or other gene-based vector and...alphavirus infection. Alphaviruses are RNA-containing viruses that cause a wide variety...by dengue virus, characterized by rash, high fever, and severe, sometimes...
... rashes clinical tools newsletter | contact Share | Heat Exhaustion, First Aid A A A Heat exhaustion signs and symptoms ... specific to the other stages of heat illness. First Aid Guide Use a combination of the following measures ...
... and rashes clinical tools newsletter | contact Share | Heatstroke, First Aid A A A Heatstroke signs and symptoms can ... specific to the earlier stages of heat illness. First Aid Guide When heatstroke is suspected, seek emergency medical ...
... and rashes clinical tools newsletter | contact Share | Splinter, First Aid A A A First Aid for Splinter: View ... wet, it makes the area prone to infection. First Aid Guide Self-care measures to remove a splinter ...
... rashes clinical tools newsletter | contact Share | Heat Cramps, First Aid A A A Heat cramp signs and symptoms ... if later stages of heat illness are suspected. First Aid Guide Use a combination of the following measures, ...
... and rashes clinical tools newsletter | contact Share | Unconsciousness, First Aid A A A Unconsciousness signs and symptoms can ... keep the airway clear while awaiting medical care. First Aid Guide If you find an unconscious person, try ...
... rashes clinical tools newsletter | contact Share | Head Trauma, First Aid A A A Head trauma signs and symptoms ... to take care for potential neck/spinal injury. First Aid Guide If you suspect either a serious head ...
... and rashes clinical tools newsletter | contact Share | Bruises, First Aid A A A Bruises lighten and change color ... Bruises can be a sign of internal bleeding. First Aid Guide If there is external bleeding in addition ...
... be moved as little as possible. Do not massage the affected area to attempt to rewarm it. ... cancer | skin rash and itch | skin of color | infant and child skin care research | explore | community | widgets | ...
Fifty patients with biopsy-proven cerebellar medulloblastoma were retrospectively analyzed for prognostic factors, survival and patterns of failure. Five- and ten-year actuarial survivals for the entire group were 51% and 42%. Survival and local control were significantly better for the 21 patients who received doses greater than 5000 rad to the posterior fossa (85% and 80% respectively) than for the remaining patients (38% and 38%, respectively). Significant prognostic factors included achievement of local control in the posterior fossa (p = .0001) and dose to the posterior fossa (p = .0005). Sex, age, duration of symptoms, extent of surgery and initial T-stage of disease were not significant. Posterior fossa was the predominant site of failure (71% of failures), but 10% of patients failed in the cerebrum and 12% outside the CNS. This experience confirms that survival rates of 70-80% are achievable with current treatment policies but accurate and consistent dose delivery to the posterior fossa is essential.
Fifty patients with biopsy-proven cerebellar medulloblastoma were retrospectively analyzed for prognostic factors, survival and patterns of failure. Five- and ten-year actuarial survivals for the entire group were 51% and 42%. Survival and local control were significantly better for the 21 patients who received doses greater that 5000 rad to the posterior fossa (85% and 80% respectively) than for the remaining patients (38% and 38%, respectively). Significant prognostic factors included achievement of local control in the posterior fossa (p = .0001) and dose to the posterior fossa (p = .0005). Sex, age, duration of symptoms, extent of surgery and initial T-stage of disease were not significant. Posterior fossa was the predominant site of failure (71% of failures), but 10% of patients failed in the cerebrum and 12% outside the CNS. This experience confirms that survival rates of 70-80% are achievable with current treatment policies but accurate and consistent dose delivery to the posterior fossa is essential.
CB6F1-TgHras2 mice (rasH2 mice) are considered to be a promising model for short-term carcinogenicity studies. This study was conducted to obtain background data for rasH2 mice, and the data were compared with those for CB6F1-nonTgHras2 mice (nonTg mice). This study revealed that the survival ratio of rasH2 mice was 92% for males and 97% for females and the body weights were lower than those of nonTg mice while plasma AST and ALT levels in rasH2 males were higher than those in nonTg males. On histopathology, higher incidences of the following neoplastic lesions were observed in rasH2 mice: hemangiosarcoma in the spleen, bronchiolo-alveolar adenoma/carcinoma in the lung in both sexes, hepatocellular adenoma in the liver, squamous cell papilloma in the forestomach, and adenocarcinoma in the Harderian glands in males. For non-neoplastic lesions in rasH2 mice, the incidences of dilatation of the glands in the glandular stomach, inflammatory cell infiltration in the submucosa of the glandular stomach, myopathy of the tongue and skeletal muscle, eosinophilic bodies in the respiratory epithelium of the nasal cavity, and basophilic renal tubules in the kidney were higher than those in nonTg mice for both sexes. In this study, various tumors and characteristic non-neoplastic lesions were observed in the rasH2 mice; furthermore, the incidence of hepatocelluler adenoma was higher than that in previous reports. These findings will be useful when evaluating the short-term carcinogenicity study using rasH2 mice.
Various types of pretreatments are used for biomass conversion of woods. The major objective of most pre treatments is to increase the susceptibility of cellulose and lignocellulose material to acid and enzymatic hydrolysis. In this study, southern mixed hardwoods were pretreated by combined rapid steam hydrolysis (RASH) and organosolv methods. It was found that the major factor in the pretreatment was the RASH temperatures. The organosolv temperature had only a minor effect on the reactivity of the final product. The enzymatic rate studies indicated that the RASH process helps in increasing the accessibility of cellulose to enzymatic hydrolysis and increased the amount of soluble lignin While the organosolv process only removed solubilized lignin. Another effect of the combined treatment was the decreasing of the enzymatic rate relative to a single RASH pretreatment. All hemicellulose is lost during these pretreatments. Three alcohols (methanol, ethanol, and butanol) were studied using a combined RASH organosolv process. At lower temperatures there were small differences between the alcohols; however, at higher temperatures all alcohols were equally effective. At longer RASH times, the percentage of glucose in the final product, as well as the amount of solubilized lignin, increased. However, the longer RASH times led to a decrease in enzymatic rates, Organosolv residence time studies of 15, 30, and 45 minutes displayed little effect on the product. Various wood-to-solvent ratios and water-to-alcohol ratios had very little effect on the yield of products. The stability of RASH treated material be fore organosolv process was studied under various storage conditions. The storage conditions had no apparent effect on the product. PMID:18587968
Allergic reactions to antiepileptic drugs in the form of skin rash are not uncommon but angioedema, an acute life threatening reaction is rare. Angioedema has been reported with the use of oxcarbazepine and carbamazepine. We report a case of a 33-year-old woman with focal epilepsy who developed angioedema following levetiracetam monotherapy. The patient had previous skin rashes with both phenytoin and lamotrigine. Levetiracetam was stopped and she improved after treatment with norepinephrine, antihistamines and corticosteroids.
Comparative efficacy study data showed that skin preparations formulated with more than 0.5% chlorhexidine gluconate (CHG) in alcohol produced significant reductions in microbial populations at the inguinal, abdominal, and antecubital sites at each sample time (P .05). It would be reasonable to expect that a 1% CHG-ethanol skin preparation (with >0.5% CHG in alcohol) could be chosen in Japan that would perform well and have promising potential for catheter preparation/maintenance preparation with consideration for recommendation of the Centers for Disease Control and Prevention's guideline issued in 2011. PMID:22222291
We describe the association of the HLA-B*1502 allele in 27 epilepsy patients (19 Malays, 8 Chinese) treated with carbamazepine (CBZ) at the UKM Medical Center (UKMMC), 6 with CBZ-Steven Johnson Syndrome (CBZ-SJS), 11 with CBZ-induced rash, 2 with suspected phenytoin-induced rash and 8 negative controls. Our study showed that 10 (6 Malay, 4 Chinese) patients were positive for HLA-B*1502. Out of the 10 patients, six were confirmed to have CBZ-SJS (p = 0.0006), while four patients developed a skin rash. However there were 6 Malay patients and 1 Chinese patient that developed a skin rash after CBZ administration who were not positive for the allele, indicating that there might be more that one allele associated with CBZ-induced hypersensitivity. Another 2 patients were suspected of having phenytoin-induced rash, instead of CBZ, and these patients did not have HLA-B*1502. In conclusion, this study confirmed the association of HLA-B*1502 with CBZ-SJS among Malaysian epilepsy patients, however there might be other genes that could be responsible for the CBZ-induced rash. PMID:22053601
Piriform fossa, trochanteric fossa and greater trochanteric tip have each been described as entry points for antegrade femoral nailing. However, the terminology used for these entry points is confusing. The accuracy of the entry point nomenclature in published text and illustrations was recorded in this review study. The trochanteric fossa, a deep depression at the base of the femoral neck is indicated as 'piriform fossa' in the vast majority of the publications. Other publications indicate the insertion site of the tendon of the piriformis muscle on the greater trochanteric tip as 'piriform fossa'. As a result of recurrent terminology error and consistent reproductions of it, the recommended entry point in literature is confusing and seems to need standardisation. The piriform fossa does not appear to exist in the femoral region. The trochanteric fossa is the standard entry point which most surgeons recommend for facilitating a standard straight intramedullary nail, as is in line with the medullary canal. The greater trochanteric tip is the lateral entry point for intramedullary nails with a proximal lateral bend. PMID:23026115
This study was aimed to determine the CT findings of nasolacrimal fossa and their clinical significance. Twenty-nine of 116 patients who underwent facial CT scanning after trauma showed evidence of nasolacrimal fracture. We retrospectively analyzed CT findings to evaluate fracture patterns of the nasolacrimal fossa and canal and associated facial fractures. To determine the frequency of associated complications, clinical records were reviewed were reviewed. Three types of fracture were identified: avulsion, comminuted,and linear. Forty-one nasolacrimal fractures, 20 of which involved the nasolacrimal fossa and 21 the nasolacrimal canal, were found in the 29 patients. Of the 20 fractures involving the nasolacrimal fossa, ten were avulsion, eight were linear, and two were comminuted. Seventeen of 21 fractures involving the nasolacrimal canal were comminuted and four were linear;all nasolacrimal fractures were associated with other facial fractures. Twenty-five of 29 fractures were the complex midfacial-type (naso-ethmoid);the remaining four were simple and unilateral. Nasolacrimal sac and duct-related complications were documented in only two patients; they experienced epiphora associated with avulsion fracture of the nasolacrimal fossa, though the probvlem was resolvced by conservative treatment without surgery. Fractures of the nasolacrimal fossa and canal were accompanied by simple or complex facial fractures. Injury-associated complications were rare, and all were associated with avulsion fractures of the nasolacrimal fossa.=20.
AbstractObjectives: Endoscopic endonasal approaches to the pterygopalatine and infratemporal fossae are technically challenging due to the complex anatomy of these areas. This project attempts to develop an anatomic and surgical model to enhance the understanding of these spaces from the endonasal endoscopic perspective. Methods: Eight pterygopalatine and infratemporal fossae were dissected in four adult human specimens in accordance with institutional protocols. All specimens were prepared with vascular injections using colored latex. Both the pterygopalatine and infratemporal fossae were accessed using a transpterygoid approach, which included a medial maxillectomy. Rod lens endoscopes (with 0 , 30 , and 45 lenses), surgical microscope, microsurgical and endoscopic instruments were used ...
Many time-based radionuclide techniques, such as glomerular filtration rate measurement (GFR), require prompt intravenous delivery of and accurately measured tracer bolus with minimal residual tracer retention at the injection site. The quality assurance aspects of two antecubital vein, quantitative injection techniques were investigated. A flush bolus technique using a tuberculin syringe piggybacked onto a 10-ml saline flush was compared to a single blood pressure cuff injection technique. Scintillation camera data for each technique were compared for bolus duration in the abdominal aorta and for residual activity at the injection site at 5 min. Bolus times were measured as the FWHM of the gamma variate fit to the abdominal aortic regional time-activity curves. Relatively little focal activity was seen in the antecubital injection site following the flush bolus: marked residual activity was seen following the blood pressure cuff injections. The injection site/arm background ratios averaged 1.3 for the flush bolus and 30.1 for the cuff technique. Although both methods allowed accurate in vitro determination of administered radioactivity, only the tuberculin syringe flush bolus technique was acceptable for time-based quantitation because of its superior in vivo characteristics.
The present study was conducted as part of an international collaborative project organized by the International Life Sciences Institute Health and Environmental Sciences Institute (ILSI-HESI project). Transgenic CB6F1 mice carrying copies of human prototype c-Ha-ras gene, CB6F1-Tg- rasH2 (rasH2) mice, were utilized as an alternative test system to a standard 2-year bioassay for carcinogenicity assessment. The antihypertensive drug reserpine, a non-genotoxic rodent carcinogen (putative non-human carcinogen), was used as a test compound for validation of these transgenic mice. Reserpine was administered to rasH2 mice at dietary concentrations of 0, 2.5, 5 and 10 ppm and to non-transgenic littermates (non-Tg) at dietary concentrations of 0 and 10 ppm for 26 consecutive weeks. The rasH2 and non-Tg mice receiving basal diet alone in the same way acted as a corresponding control. A single intraperitoneal injection of N-methyl- N-nitrosourea (MNU) to rasH2 mice served as a positive control. All surviving animals were sacrificed 26 weeks later and subjected to histopathological examination. Alveolar/bronchiolar adenoma and carcinoma of the lung, hemangiomas and hemangiosarcomas of the spleen, and papilloma of the forestomach were sporadically detected in rasH2 mice fed either the reserpine-containing diet or basal diet. No specific hyperplastic or neoplastic lesions due to reserpine were detected. In MNU-treated mice, however, thymic and/or systemic malignant lymphomas and squamous cell papilloma and/or carcinoma in the forestomach were commonly detected in both males and females with low survival rates suggesting the sensitivity of assay conditions. In conclusion, no carcinogenicity of reserpine was identified in rasH2 mice under the present experimental conditions.
A generalized skin eruption with strong itching was induced by sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor, in a patient almost 6 months after initiation of the drug. Physical examination revealed a spread of skin rash from chest to back, and abdomen and thigh. Discontinuation of the drug eliminated the skin rash immediately. The emergence of new rash ended, and the rash itself withered after 1 week. The spread of the rash gradually shrank and the skin lesions subsided, leaving pigmentation 1 month later. Two months after cessation of sitagliptin, the skin eruption had subsided and oral steroid medication was stopped, but some small eczematous eruptions continued to appear intermittently. Although a drug-induced lymphocyte stimulation test was negative for sitagliptin, nonspecific radioimmunosorbent test for immunoglobulin E was increased to 532 IU/mL, with a percentage of eosinophil of 7.4%. Sitagliptin has a phenyl ring, carbonyl group, and an absorption spectrum showing three absorption peaks (199.9, 265.0, 400.1 nm), and its photosensitive mechanism could have been responsible for the itchy edematous plaque. In the present case, the initial generalized skin eruption may have been induced by an allergic reaction to sitagliptin. Close attention should be paid to patients receiving this drug with a history of urticaria, and to the development of photosensitivity. PMID:23129260
A case of paragonimiasis involving the left ovary is reported. The ultrasonographic examination detected a homogeneously echogenic mass in the left iliac fossa in association with enlargement of the adjacent lymph nodes, mimicking an ovarian cancer
... depending on the age of the child, midfacial growth is one of the most important things that ... Blood is a wonderful, wonderful medium for the growth of bacteria. It will allow your temporal fossa ...
The longitudinal profiles of inverted fluvial features located in the Medusa Fossae Formation exhibit undulations that we interpret as evidence of post-fluvial deformation of the region. We propose and evaluate possible deformation processes.
The lower member of the Medusae Fossae Formation (MFF) has two mappable subdivisions within the quadrangle, including several outliers interpreted to be MFF materials. Layering in outliers is similar to layering in nearby portions of globally mapped MFF deposits.
One hypothesis for the source of dark dune sediments on Mars is volcaniclastic sediments. Comparison between dark dunes in the western Medusae Fossae Formation and dark dunes derived from an Andean ignimbrite supports this hypothesis.
Topographic analyses of sinuous ridges in the western Medusa Fossae Formation (MFF) show gradients locally reversing direction of slope along the presumed flow direction, interpreted as indication of differential settling of the western MFF.
Six different brain tumors in middle cranial fossa are presented which are studied by CT and proved pathologically. The authors experienced rare tumors in middle cranial fossa such as cavernous hemangioma, cystic meningioma, Schwannoma, Masson's vegetant intravascular hemangioendothelioma and other tumors (arteriovenous malformation and metastatic adenoid cystic carcinoma) whose CT findings were atypical. The results are as follows; 1. In case of tumors in middle cranial fossa, basal and coronal sections are necessary for further evaluation of the relations with dura and adjancent bone change. 2. In suspicion of metastasis, bone setting should be done to find out bone involvement. 3. Internal carotid angiography gave little help in the differential diagnosis of tumors in middle cranial fossa.
On ancient Mars, water carved channels and transported sediments to form fans and ... The High Resolution Imaging Science Experiment (HiRISE) camera on ... Ceraunius Fossae is the region of fractures and volcanic flows south of Alba ...
OBJECTIVE: "Cerebellar mutis" and subsequent dysarthria (MSD) is a documented complication of posterior fossa surgery in children. In this prospective study the following risk factors for MSD were assessed: type, size and site of the tumour; hydrocephalus at presentatio...
Vestibular schwannomas (VS) are a common posterior fossa brain tumor, and though benign can cause significant morbidity, particularly loss of hearing, tinnitus, vertigo and facial paralysis. The current treatment options for VS include microsurgical resection, stereotactic radiosurgery or close surv...
... opposite shoulder lines up carefully to avoid nerve injury with no pressure on the popliteal fossa. We ... here, which we feel is affected by radiation injury but not by cancer. Now we switch back ...
Abstract Aim- Port placement in laparoscopic surgery has important ergonomic implications. A manipulation angle (MA) of 60 has been shown to maximize task efficiency. We calculated the MA used during various stages of both right hemicolectomy (RH) and high anterior resection (AR). Method- We compared two methods of port placement for each operation. RH-PP1 included ports in the left iliac fossa and left upper quadrant. RH-PP2 included ports suprapubically and in the left iliac fossa. We calculated the MA of each of these methods in mobilizing both the caecum and hepatic flexure. AR-PP1 included ports in the right iliac fossa and right upper quadrant. AR-PP2 included ports suprapubically and in the right iliac fossa. We calculated the MA of each of these methods in mobilizing the splenic fl...
The aim of the study was to present consecutive stages of the extended subtemporal approach (ESA). Seven simulations of ESA were performed on non-fixed human cadavers without any known pathologies in the head and neck. The consecutive stages of the procedure were documented with photographs and schemes. The starting point for ESA is osteotomy of the zygomatic arch and craniectomy including the greater wing of the sphenoid bone. Dislocation or removal of subtemporal fossa contents allows one to penetrate its inside and related structures. Additional widening of inspection allows osteotomy of the condyloid process of the mandible. ESA is a reproducible technique which provides surgical penetration of the subtemporal fossa and related structures. This approach is particularly useful in the surgical treatment of tumours expanding in the orbit, maxillary sinus, pterygopalatine fossa, nasopharynx, sphenoid sinus, cavernous sinus, parapharyngeal space, retromandibular fossa and surroundings of the petrosal part of the internal carotid artery. PMID:20496286
... a wonderful, wonderful medium for the growth of bacteria. It will allow your temporal fossa to become…or, your implant to become colonized with bacteria and then allow them to…to multiply. And ...
Cerebellar mutism is a common complication of posterior fossa surgery in children. This article reviews current status with respect to incidence, anatomical substrate, pathophysiology, risk factors, surgical considerations, treatment options, prognosis and prevention.
To describe occipitalization on human dry skulls and to compare craniofacial morphology including the posterior cranial fossa in skulls with occipitalization and in skulls without occipitalization and with normal craniofacial morphology (controls).
A female with the orocraniodigital (Juberg-Hayward) syndrome is described in whom, in addition to bilateral cleft lip and palate, mild microcephaly, and anomalous thumbs and toes, there was absence of the pituitary fossa and a more widespread skeletal dysplasia.
A 49-year-old female presented with a rare giant schwannoma arising from the dura mater of the middle fossa manifesting as loss of left visual acuity. Magnetic resonance imaging revealed a heterogeneously enhanced giant mass in the left middle fossa. Surgery via the transsylvian approach confirmed the origin of the tumor between the left internal carotid artery and the trigeminal nerve in the lateral wall of the cavernous sinus. Elongated abducens nerve was confirmed, but no tumor adhesion to the abducens nerve was found. The tumor was closely attached to the dura mater of the middle fossa and the lateral wall of the cavernous sinus. The histological diagnosis was schwannoma. Both left oculomotor and abducens nerve pareses occurred immediately after the operation but gradually resolved over 3 months. The operative findings indicated that this schwannoma may have arisen from the meningeal branch of the trigeminal nerve in the dura mater of the middle fossa.
Spectral analysis of Nili Fossae phyllosilicates reveals evidence for the presence of talc (not saponite) and mixed-layer clay. These findings provide further evidence that carbonation of serpentine is the formation mechanism for carbonates on Mars.
... nice exposure of our acetabular fossa. Let’s go deep, deep. Now in terms of patient positioning for acetabular ... don't, but this is a very nice time that we can access those osteophytes that we ...
Abstract in portuguese Os autores empregaram detalhes técnicos pessoais para descompressão da fossa posterior em casos de impressão basilar e/ou maliormação de Arnold-Chiari, consistente em intuoação endotraqueal sem retroflexão da cabeça do paciente, sendo o mesmo operado em posição sentada e com a cabeça ereta. Foi realizada plástica da paquimeninge da fossa posterior com dura-mater de cadáver conservada em glicerina. Abstract in english The surgical technic for decompression of the posterior fossa in cases of basilar impression and malformation of Arnold-Chiari mainly based in (1) endotracheal intubation without any flexion of the head, (2) position of the head without anterior flexion during the surgery, (3) plastic of the posterior fossa with dura-mater of cadaver conserved in glicerina, was emploied in 13 patients. The plastic was made to create space at the craniocervical joint in order to avoid cerebrospinal fluid fistula and to restore the integrity of the dura. Infection was not observed.
58 case of proven primary posterior fossa tumor examined by CT scanner were analyzed. The CT appearance in acoustic neurinoma, trigeminal neurinoma, meningioma, dermoid, astrocytoma, hemangioblastoma, medulloblastoma, and ependymoma are described and the differential diagnosis are discussed.
A case of posterior fossa meningeoma with extracranial projection in a three years old female child is reported. The rarity of the process, its localization and the age group committed are emphasized. The radiological findings first suggesting an aneurismatic bone cyst like are commented. The surgical treatment with a posterior fossa approach and good results observed as well as the rarity of this pathology justify the report. PMID:6535559
Since its arrival at Vesta on July 16th 2011, NASA’s Dawn spacecraft has collected spectacular imaging, compositional and geophysical data. Dawn is scheduled to depart Vesta on August 26th and during this eventful year many unexpected discoveries have been made about this diverse asteroid. One such discovery is the Saturnalia Fossa trough in Vesta’s northern hemisphere. Saturnalia Fossa is the chief structure of at least 5 parallel troughs, many of which partly coalesce into one another at various locations. The sizeable Saturnalia Fossa dominates Vesta’s northern hemisphere and lends its name to the Saturnalia Ridge and Trough Terrain. Saturnalia Fossa has a maximum width of 39 km, making it almost twice the width of the 22 km wide Divalia Fossa equatorial trough. Currently Saturnalia Fossa ( 366 km long) is shorter than Divalia Fossa ( 465 km long) (Buczkowski et al., 2012, submitted to GRL). But, Saturnalia Fossa extends into the currently shadowed northern region and its length will increase as Dawn gains coverage in this enigmatic area. The northern troughs are covered in an obscuring layer of regolith, which makes identifying their specific form challenging. Comparative planetology, along with the analysis of Dawn data, helps to indicate whether the troughs are graben or another structure. The orientation of the troughs makes it likely that their formation is linked to that of the southern Veneneia basin (Buczkowski et al., 2011, AGU). There are many smaller structures, which include grooves, pit crater chains and small ridges that are preferentially oriented sub-parallel or sub-perpendicular to the troughs. This suggests that they have a related formation mechanism. An initial analysis of the distribution of the troughs and smaller structures indicates that they are oriented as if they were formed by large-scale shearing. This shear is possibly a result of the Veneneia-forming impact.
Abstract in portuguese Com o advento da tomografia computadorizada, a avaliação dos locais de acometimento e extensão do nasoangiofibroma juvenil tornou-se mais precisa, o que facilitou o correto estadiamento pré-operatório. O objetivo deste trabalho é avaliar a concordância interobservadores, por meio da análise por tomografia computadorizada, de 15 casos de nasoangiofibroma juvenil em relação à extensão para locais relacionados com altos índices de recidivas. Todos os pacientes e (more) ram do sexo masculino, com idade média de 15,8 anos. A análise da concordância entre os observadores quanto à extensão e envolvimento da fossa infratemporal, seios esfenóide e cavernoso e fossa craniana média foi excelente, em relação à fissura orbitária superior foi boa e em relação à base do processo pterigóide e fossa craniana anterior foi ruim. Concluiu-se que a análise apresenta alta concordância entre os observadores para os locais estabelecidos, com exceção da base do processo pterigóide e da fossa craniana anterior. Abstract in english The advent of computed tomography permitted a much more precise evaluation of tumor localization, thus facilitating presurgical staging. The objective of this study was to evaluate the interobserver agreement on the analysis of computed tomography scans of 15 patients with juvenile nasopharyngeal angiofibroma, regarding assessment of tumor extension to sites of high recurrence rate. All patients were male and had a mean age of 15.8 years. The results of the interobserver (more) agreement analysis regarding tumor invasion and extension to the infratemporal fossa, cavernous sinus, sphenoid sinus and medium cranial fossa were excellent. Identification of involvement of the superior orbital fissure was considered good. Interobserver agreement regarding tumor extension to the base of pterigoid process and anterior cranial fossa was considered poor. We concluded that there is a very good interobserver agreement on the evaluation of the established localization of tumor invasion, except when evaluating the base of the pterigoid process and the anterior cranial fossa.
Chiari type II malformation (CMII) is one of three hindbrain malformations that display hydrocephalus. We have observed that cerebrospinal fluid (CSF) signal in the posterior fossa, which is always apparent on normal fetal MR images, is not visible in a fetus with CMII. We use the term 'tight posterior fossa' for this MR imaging finding, and evaluate the diagnostic value of this finding on fetal MR images. Included in the study were 21 fetuses which underwent brain MR imaging at 1.5 T using two-dimensional balanced turbo-field-echo (2-D balanced-TFE) in the axial and sagittal planes. Postnatal diagnoses were CMII (n=5), CNS abnormalities other than CMII (n=8), and no abnormality (n=8). A tight posterior fossa was defined as an absent or slit-like water signal space around the hindbrain in the posterior fossa on both sagittal and axial MR images. All CMII fetuses displayed a tight posterior fossa on MR images. Hydrocephalus was visualized in all CMII fetuses and myelomeningocele in four fetuses, but hindbrain herniation was visualized only in two of five fetuses. The CSF signal surrounding the hindbrain was clearly visible in all the other 16 fetuses, including five with hydrocephalus not associated with CMII, although it was slightly narrower in a fetus with a cloverleaf skull than in the normal fetuses. Tight posterior fossa in the presence of hydrocephalus is a useful and characteristic finding of CMII on fetal MRI. (orig.)
A retrospective review was performed of patients treated for middle ear cholesteatoma with bone defects of the skull base via a combined transmastoid/middle fossa approach at the University of Tsukuba Hospital from 2006 through 2011 to determine the safety and effectiveness of a combined transmastoid/middle fossa approach for the treatment of cholesteatoma involving the middle cranial fossa. The bone defects of the skull base were reconstructed with a galeal flap pedicled with a parietal branch of the superficial temporal artery and an autologous bone flap. The clinical and radiological data were analyzed. This series included 8 patients (6 men and 2 women) with a mean age of 46.3 years (range 10-67 years). One of the patients preoperatively exhibited meningoencephalocele of the middle fossa skull base, and in the remaining 7 patients, petrous bone involvement such as involvement of the supralabyrinthine cells was observed. The cholesteatoma lesion was totally removed and inner ear function preserved in all the patients. Cerebrospinal fluid leakage was observed in 1 patient during and after the surgery. Neither meningitis nor recurrence was observed in any patient during the follow-up periods (mean 29.4 months, range 6-64 months). The combined transmastoid/middle fossa approach allowed complete removal of cholesteatoma with middle cranial fossa involvement while preserving hearing and preventing postoperative cerebrospinal fluid leakage and meningitis.
A retrospective review was performed of patients treated for middle ear cholesteatoma with bone defects of the skull base via a combined transmastoid/middle fossa approach at the University of Tsukuba Hospital from 2006 through 2011 to determine the safety and effectiveness of a combined transmastoid/middle fossa approach for the treatment of cholesteatoma involving the middle cranial fossa. The bone defects of the skull base were reconstructed with a galeal flap pedicled with a parietal branch of the superficial temporal artery and an autologous bone flap. The clinical and radiological data were analyzed. This series included 8 patients (6 men and 2 women) with a mean age of 46.3 years (range 10-67 years). One of the patients preoperatively exhibited meningoencephalocele of the middle fossa skull base, and in the remaining 7 patients, petrous bone involvement such as involvement of the supralabyrinthine cells was observed. The cholesteatoma lesion was totally removed and inner ear function preserved in all the patients. Cerebrospinal fluid leakage was observed in 1 patient during and after the surgery. Neither meningitis nor recurrence was observed in any patient during the follow-up periods (mean 29.4 months, range 6-64 months). The combined transmastoid/middle fossa approach allowed complete removal of cholesteatoma with middle cranial fossa involvement while preserving hearing and preventing postoperative cerebrospinal fluid leakage and meningitis. PMID:23095266
Abstract Objective: Over 50% of cancer patients who are treated with epidermal growth factor receptor (EGFR) inhibitors develop a papulopustular rash that involves the face, neck, and upper torso. However, because relatively few previous reports have focused on the full ramifications of this drug-induced side effect, this qualitative study was undertaken. Methods: Fifteen patients who had either an active or previous rash from these agents participated in scripted interviews. All interviews were transcribed and examined by means of a qualitative methodologic approach. Results: Four major themes emerged: (1) actual physical discomfort was associated with the rash; (2) patients were concerned about their appearance; (3) despite initial denial, patients did suffer social isolation; and (4) hi...
Summary An oral formulation of temsirolimus (Torisel®), an inhibitor of the mammalian target of rapamycin, was evaluated on an intermittent schedule (once daily for 5 days every 2 weeks) in patients with advanced cancer. The maximum tolerated dose was determined to be 75 mg after dose-limiting toxicities of grade 3 elevated aminotransferases (1 patient) and grade 3 rash (1 patient) occurred with a 100-mg dose. The most common temsirolimus-related adverse events were mucositis, rash/maculopapular rash, and asthenia. Six of 12 patients who received the 75-mg dose required dose reductions due to temsirolimus-related adverse events. Two patients who received 75-mg temsirolimus and did not have dose reductions had minor tumor responses. Relative exposure from contributions of both temsirolimus ...
Purpose To investigate associations between germline genetic variations in the epidermal growth factor receptor (EGFR) and toxicity in paediatric patients treated with gefitinib. Patients and methods Gefitinib treatment and toxicity data from five paediatric clinical trials were combined. EGFR genotypes evaluated included -191C>A, -216G>T, Arg497Lys and intron 1 CA sequence repeat number. The genetic variations were evaluated for associations with grade one or greater rash or diarrhoea during the first course of treatment. Results The analysis included 110 patients, 60 (55%) with grade one or greater rash and 47 (43%) with grade one or greater diarrhoea. Among patients with the -216 GG (n=51), GT (n=41) and TT (n=16) genotypes, grade one or greater rash occurred in 52.9%, 46.3% and 87.5% o...
Background:We investigated the association between skin rash and plasma creatine kinase (CK) levels in oncology phase I trials.Methods:We analysed data from 295 patients treated at our institution within 25 phase I trials which included CK measurements in the protocol. Trials involved drugs targeting EGFR/HER2, m-TOR, VEGFR, SRC/ABL, aurora kinase, BRAF/MEK, PARP, CDK, A5B1 integrin, as well as oncolytic viruses and vascular disrupting agents.Results:Creatine kinase measurements were available for 278 patients. The highest levels of plasma CK during the trial were seen among patients with Grade (G) 2/3 rash (median 249?U?l?1) compared with G1 (median 81?U?l?1) and no rash (median 55?U?l?1) (P<0.001). There was a significant reduction in...
Introduction EGFR inhibitors (EGFRIs) have been shown to be clinically effective in various cancers. Unique skin toxicity is commonly observed with EGFRIs and a correlation between the clinical benefit of EGFRIs and this characteristic rash has been reported. Erlotinib is a potent EGFRI approved for treatment of non-small cell lung cancer (NSCLC) and pancreatic cancer. Methods This is the first time in which patients were given increasing doses of an EGFRI to induce a mechanistic rash and study its associated pathology in skin. Biopsies were collected during treatment from both rash-affected and unaffected skin of 23 NSCLC patients and compared with pre-treatment biopsies. Results Altered differentiation of appendegeal epithelium (hair follicles and sebaceous glands) was remarkable in both...
A 2-week-old infant born at 36-week gestation developed diarrhea and metabolic acidosis when he was put on formula feeding. He was treated for sepsis and was screened for metabolic diseases. Blood and cerebrospinal fluid cultures were clear. The diarrhea and metabolic acidosis settled but recurred when formula feeding was resumed. He developed a florid erythematous rash involving the palms, feet, perioral and perineal regions. Zinc deficiency was confirmed and zinc replacement resulted in prompt resolution of the skin rash. The patient was put on Pepti-Junior and remained well. This case illustrates that zinc deficiency must be sought and treated in an infant with a typical rash involving the palms, feet and body orifices.
Summary Background. Drug-induced hypersensitivity syndrome (DIHS)/drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is characterized by late disease onset, fever, rash, hepatic dysfunction, haematological abnormalities, lymphadenopathy and often, human herpesvirus (HHV) reactivation. The diagnosis of DIHS is based on the combined presence of these findings. Anticonvulsants are a major cause of DIHS and may also cause Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). We examined whether SJS/TEN due to anticonvulsants display similar clinical and laboratory features seen in DIHS. Methods. Patients diagnosed with SJS or TEN due to anticonvulsants (n = 8) were examined and their clinical features and laboratory findings were compared with patients with antic...
An analysis of Ron Rash's novel One Foot in Eden, focusing on his attachment to place and his depiction of the internal conflicts between farmers and townspeople in a small Appalachian community. Rash depicts the contemporary Southerner’s struggle to maintain his or her roots in a time of rapid homogenization. The inherent conflicts in his fiction are simultaneously a reminder of the necessity of living with one’s past and a fierce attack on today’s merciless industrialization. The novel ultimately resonates with the continuous changes of the South in the new millennium.
We describe 11 cases of anti-tuberculosis DRESS (drug-related rash with eosinophilia and systemic symptoms) syndrome, a potentially serious complication of treatment that led to interruption of treatment for prolonged periods, systemic corticosteroid use and the resumption of treatment with less effective regimens. All patients had rash and toxic hepatitis, one died of multi-organ failure and, contrary to expectations, the evolution of tuberculosis (advanced in most cases) did not progress under corticosteroid treatment. The drug most frequently involved was rifampicin, while retreatment schemes included, in most cases, levofloxacin, ethambutol, streptomycin and cycloserine. PMID:23114284
? Human parechovirus type 3 (HPeV3) is known to cause sepsis-like syndrome and meningoencephalitis in neonates and young infants. We herein report a neonatal case of sepsis-like syndrome due to HPeV3 infection, diagnosed using polymerase chain reaction (PCR), with a distinctive erythematous rash present mainly on the soles and palms that helped in the diagnosis of the disease. Combining the unique characteristics of rash and confirmation by PCR at the early stage of the disease led to the diagnosis of HPeV3, distinguishing it from sepsis and other critical disease conditions, and allowing for appropriate, rapid management. PMID:22938181
Fournier's gangrene is uncommon in pediatric age group, and little is known about the disease in the newborn period and infancy. Three patients, aged 10 days, 14, and 17 months, with Fournier's gangrene, were treated in our hospital. The predisposing factors were prematurity, a diaper rash, and varicella infection, respectively. Especially, prematurity and diaper rash are rare predisposing factors in the pediatric population; therefore, high index of suspicion, prompt diagnosis, conservative surgery, and multidisciplinary approach are the mainstays of management in children with Fournier's gangrene.
Drug rash with eosinophilia and systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome (DIHS), is a severe adverse drug reaction affecting multiple organs caused by drug treatment. The current report describes a man who was prescribed zonisamide for epilepsy and subsequently developed widespread skin rash, acute kidney injury, high-grade fever, eosinophilia, liver dysfunction, lymphadenopathy and an increase in antihuman herpesvirus-6 immunoglobulin G titer. Hypersensitivity to zonisamide was confirmed by the skin patch test. Based on these findings, the patient was diagnosed with DRESS/DIHS caused by zonisamide. This is the first report of acute kidney injury due to zonisamide-induced DRESS/DIHS.
Rickesttsial diseases are a group of diseases caused by obligate intracellular gram negative bacilli and transmitted to man by arthropod vectors (except Q fever). It is increasingly realised that rickesttsial diseases are underdiagnosed. It is now well documented that rickettsial disease is prevalent all over India, in pockets. The hallmark of rickettsial infection is microvasulitis, causing microinfarcts in various organs. Usually the patients present with classical triad of Fever, Headache & Rash. Apart from this, pain in legs, oedema, Gastro-intestinal symptoms, hepato-splenomegaly, anaemia, necrotic rash, gangrene of digits, toes, earlobes, scrotum, painless eschar and lymphadenopathy are other manifestations. Complications include encephalitis, ARDS, pneumonia, Myocarditis, Renal fail...
We present a patient who developed carbamazepine (CBZ)-induced Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome associated with high serum procalcitonin (PCT). The presentation (high fever, hepatosplenomegaly, leukocytosis), high PCT and CRP initially suggested sepsis, and he was treated with antibiotics, while CBZ was continued. The rash and hepatitis worsened. After withdrawal of CBZ, corticosteroid therapy was administered and the patient recovered with normalization of PCT. This case demonstrates that PCT may be increased in patients with DRESS. This is the first report of CBZ-induced DRESS associated with high PCT, and the second case of increased PCT in DRESS.
A hydrostatic rise in forearm vascular transmural pressure may be associated with an increase in forearm blood flow (FBF) that causes pain. To test this hypothesis, forearm vascular transmural pressure was elevated in eight male volunteers by a series of 1-min hypobaric exposures of the left arm to incrementing differential pressures of 40, 80, 120, 140, 160 and 200 mmHg. The series was repeated after a 30-min interval. Forearm venous pressure (FVP) was measured in the median antecubital vein, and FBF was determined by ultrasound Doppler in the axillary artery. Pain level was recorded by numerical rating scale. In all subjects, an increase in FBF and forearm vascular conductance (FVC) occurred (P exposures, increases in FBF, FVC and pain occurred at a lower transmural pressure (FVP 152 +/- 15 mmHg, P exposure to high transmural pressure. This may explain the overt forearm pain experienced by the crews of high performance military aircraft during manoeuvring. PMID:17476524
Promethazine is a commonly used medication to treat nausea and motion sickness. Case reports have recently surfaced on the dangers of parenteral administration of promethazine. We present a case report of a presumed intravenous injection of promethazine into an antecubital intravenous line resulting in necrosis of the ring finger distal to the DIP joint and hypoperfusion of the digits. Peripheral sympathectomy was performed to improve nutritional flow and improve ischemic pain. However, although this novel treatment option was successful, ultimately the patient had an amputation of her ring finger at the level of her middle phalanx. Although no proven successful treatment exists, the updated treatment options following inadvertent intra-arterial or perivascular administration are presented...
Radionuclide studies were performed on 12 patients who had had a Fontan operation for cyanotic congenital heart disease, six of whom had undergone a prior palliative Glenn procedure. The patients without prior Glenn anastomoses were studied by radionuclide first-pass angiocardiography, using a right antecubital vein injection of /sup 99m/Tc pertechnetate. The patients with Glenn anastomoses required two injections, one by femoral vein to study the Fontan procedure, using bolus injection of /sup 99m/Tc pertechnetate or microspheres, and the second by right anetcubital vein to study the Glenn anastomosis and right lung, using a bolus of microspheres. Noninvasive radionuclide methods seem to be dependable in the postoperative evaluation of patients after the Fontan procedure. First-pass angiocardiography is most helpful in evaluating the dynamics and distribution of blood flow, especially the right atrial output, and gated blood-pool scintigraphy offers a better evaluation of right atrial and left ventricular contraction, so both supply complementary information.
Meglumine/sodium diatrizoate was administered as a one minute bolus of 60 ml. (60%) and subsequent 5 minute infusion of 250 ml. (24%) into antecubital veins during pelvic CT Scanning of 15 patients. Blood samples were taken from the opposite arm before and at 1 and 5 minutes after starting the contrast medium injection. The average plasma concentrations of diatrizoate were 2.2 +- 0.5 and 3.8 +- 0.8 mg./ml. in the 1 and 5 minute blood samples, respectively. The systematic levels of thromboxane A/sub 2/ (TXA/sub 2/) increased in 10 patient's plasma during contrast medium infusion while the level of prostacyclin (PGI/sub 2/) remained unchanged. One patient had immediate adverse reaction due to contrast without any changes in PGI/sub 2/ of TXA/sub 2/ levels. Contrast medium infusion increased the systemtic ratio of TXA/sub 2//PGI/sub 2/ which may predispose to hemostatic disorders.
Abstract in spanish Se estudió cómo se comporta el transporte de anticuerpos anti-estreptoquinasa entre la madre y el recién nacido y cuáles son los factores que influyen en este. Se colectaron 125 muestras sanguíneas de puérperas, por la vena antecubital y de sus respectivos hijos a partir del cordón umbilical. Se confeccionaron encuestas para la recolección de datos a partir de las historias clínicas de las madres y los recién nacidos. Se empleó un método inmunoenzimático, het (more) erogéneo, cualitativo, tipo sandwich de doble antígeno para la detección de anticuerpos anti-estreptoquinasa. A partir de los resultados obtenidos se concluyó que existe un transporte activo de los anticuerpos anti-estreptoquinasa de la madre al feto y que este transporte se ve influenciado por la edad cronológica de la madre, la edad gestacional, el estado nutricional de la madre y el peso del recién nacido. Abstract in english The behavior of the transport of streptokinase antibodies from the mother to the newborn infant, as well as the factors influencing on it, were studied here. 125 blood samples were obtained from the antecubital vein of the puerperas and from the umbilical cord of their children. Surveys were done to collect data from the medical histories of the mothers and the newborn infants. An immunoenzimatic, heterogenous and qualitatitve sandwich doble antigen method was used to det (more) ect anti-streptokinase antibodies. According to the results, it was concluded that there is an active transport of anti-streptokinase antibodies from the mother to the fetus and that this transport is influenced by the chronological age of the mother, the gestational age, the mother?s nutritional status and the birth weight.
First-pass radionuclide angiography (FPRNA) using a multi-crystal gamma camera can correctly provide many quantitative and qualitative indices of left ventricular function as well as anatomic information. A compact injection bolus of radiotracer is, however, essential to the first-pass study since the temporal separation of cardiac chambers is required for the first-pass acquisition. To examine which factors affect the quality of an injection bolus, 327 patients who had FPRNA in the anterior projection were randomized for injection site of radiotracer (right or left external jugular veins, and right antecubital vein) and needle size (19- or 21-gauge). The injected bolus was assessed from the full width at half maximum (FWHM) of the bolus time-activity curve in the superior vena cava. As to injection site using a 19-gauge needle, an attemption through right external jugular vein (EJV) revealed the shortest FWHM of an injection bolus, followed by left EJV and right antecubital vein (AV). In right EJV 91% of injected bolus FWHM was less than 1.5 sec, which was significantly higher (p<0.001) than those of the other sites (left EJV: 70%. right AV: 65%). Approximately 7% of injection from left EJV and right AV, showed a split bolus of radiotracer. However, no split bolus was observed from right EJV. There was no significant difference in FWHM of an injection bolus between 19- and 21-gauge needle from EJV. Our present study demonstrated that the quality of an injection bolus from left EJV and AV was affected by RVEF in a case of low right ventricular function. In conclusion, right EJV is the first choice of injection site to obtain a compact bolus of radiotracer for the first-pass cardiac study. A 21-gauge needle can also be inserted from the external jugular vein to perform a good bolus injection. (author)
Atopic dermatitis or eczema is characterized by skin rashes and itching is an inflammatory disease that affects 10-20% of children and 1-3% of adults. Staphylococcus aureus bacteria are present on the skin of nearly all patients with atopic dermatitis. Antibiotics that suppress colonization of S. au...
We encountered a boy with periodic fever, aphthous-stomatitis, pharyngitis, adenitis syndrome, complicated by a papular rash representing pityriasis lichenoides et varioliformis acuta. Proinflammatory cytokines have been implicated in both diseases and may represent the underlying common immunologic mechanism causing the two diseases. PMID:21504456
Abstract:- We encountered a boy with periodic fever, aphthous-stomatitis, pharyngitis, adenitis syndrome, complicated by a papular rash representing pityriasis lichenoides et varioliformis acuta. Proinflammatory cytokines have been implicated in both diseases and may represent the underlying common immunologic mechanism causing the two diseases.
... of the bone itself and is quite painful. Relief from pain often requires total surgical joint replacement. ... are most often prescribed for skin rashes, mouth ulcers, and joint pain, but also ... blood pressure, higher glucose levels and higher cholesterol. Prednisone can ...
Aug 31, 2006... aggravate asthma and lead to the premature aging of lung tissue. Other components of air pollution can cause eye irritation, skin rashes, headaches, and sore throats. ... most pollutants are emitted by both natural and human sources. ... food, making it vulnerable to disease, pests, and inclement weather.
We report the case of an 86-year-old man with acute left shoulder pain, followed by left limb monoparesis and a herpetic rash on the left upper limb and thoracic region. This situation presented a diagnostic challenge because of the simultaneity of symptoms attributable to Parsonage-Turner syndrome ...
Abstract in portuguese CONTEXTO: A síndrome DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) é um tipo de reação a drogas comumente confundida com uma infecção viral. Deve ser prontamente reconhecida devido a sua alta morbidade e taxa de mortalidade de 10%. Poucos casos de síndrome DRESS induzida por sulfasalazina foram relatados na literatura. RELATO DE CASO: É relatado o caso de uma mulher branca, brasileira, de 47 anos, que desenvolveu a síndrome DRESS oito semanas após in (more) iciar tratamento com sulfasalazina para artrite soronegativa. A paciente apresentou rash maculopapular, febre, hepatite, linfadenomegalia, eosinofilia e linfocitose atípica. A medicação foi suspensa imediatamente no início dos sintomas, mas só houve melhora clínica após tratamento com prednisona. Abstract in english CONTEXT: DRESS syndrome (Drug Rash with Eosinophilia and Systemic Symptoms) is a type of drug reaction commonly mistaken for a viral infection. It must be recognized promptly due to its high morbidity and 10% mortality rate. Few cases of DRESS syndrome induced by sulfasalazine have been reported in the literature. CASE REPORT: The case of a 47-year-old white Brazilian woman who developed DRESS syndrome eight weeks after starting a course of sulfasalazine for treatment of (more) seronegative arthritis is reported. She presented a skin rash, fever, hepatitis, lymphadenopathy, eosinophilia and atypical lymphocytes. The causative drug was discontinued immediately, but she only improved after treatment with prednisone.
To examine the tumor-promoting effect of troglitazone (TRG), a novel thiazolidinedione insulin-sensitizing agent, on splenic hemangiosarcomas in rasH2 mice, histopathological and molecular analyses were performed in the spleen of female rasH2 mice fed a diet containing 6,000 or 0 ppm TRG for 16 weeks after 1,000 or 0 mg/kg urethane (UR) initiation. Histopathologically, splenic hemangiosarcomas were observed in the UR-alone and UR+TRG groups, but there was no significant difference in the incidence of splenic hemangiosarcomas between the UR-alone and UR+TRG groups. There were increasing tendencies in the number of positive cells for anti-PCNA antibody and gene expression in the UR+TRG group, but such a change was not statistically significant as compared to that in the UR-alone group. The gene expressions of VEGF, VEGFR1, VEGFC, VEGFR2 and Tie2 related to angiogenesis; c-fos related to MAPK cascade activation; and cyclin D1 related to cell cycle in the UR-alone and UR+TRG groups were significantly higher than those in the untreated control group. However, only the Tie2 gene in the UR+TRG group was significantly increased as compared to that in the UR-alone group. These results suggest that the vascular tumor-promoting activity of TRG in rasH2 mice is extremely low in the present experimental condition and a part of the gene related to angiogenesis probably contributes to the promotion of splenic hemangiosarcomas in rasH2 mice given TRG. (orig.)
... and rashes clinical tools newsletter | contact Share | Bedbug Bite Information for adults A A A Bedbug bites can have a central darker area within the ... up to a year without a meal. Their bite is painless, so you will likely not be ...
A 10-year old female on phenytoin therapy developed a rash and lymphadenopathy. H.p.l.c. assays of urinary metabolites indicated no differences in stereoselective metabolism of phenytoin to phenolic and dihydrodiol metabolites as compared with volunteers given the drug or with pediatric patients wit...
Radiation therapy is a common treatment for cancer patients. One of the most common side effects of radiation is acute skin reaction (radiation dermatitis) that ranges from a mild rash to severe ulceration. Approximately 85% of patients treated with radiation therapy will experience a moderate-to-se...
Sixteen cases of either a pityriasiform or discoid eczematous rash occurring in patients with rheumatoid arthritis receiving treatment with gold (sodium aurothiomalate and auranofin) were studied. The results suggest that this is a dose related, not allergic, reaction to gold. The development of thi...
In a retrospective and prospective audit of 55 children presenting to the paediatric assessment unit of a district general hospital with fever and petechial rash, 9% had significant bacterial sepsis. The "ILL criteria" (irritability, lethargy, low capillary refill) for the management of children wit...
Four guests at a ski resort in Vermont reported contracting a characteristic papular, pustular, or vesicular rash after using the resort's whirlpool. Pseudomonas aeruginosa serotype 1, bacteriophage type 86, was isolated from a pustule on one patient, water within the whirlpool, and the whirlpool di...
... one of the most common forms of eczema, atopic dermatitis. About 10 percent to 20 percent of the world's population is affected by this chronic, relapsing, and very itchy rash at some point during childhood. It occurs most often on the face and ...
... are many types of dermatitis, including: Atopic dermatitis (eczema). It's a common, hereditary dermatitis that causes an itchy rash primarily on the face, trunk, arms, and legs. It commonly develops in infancy, but can also appear in early childhood. It may be associated with allergic diseases such ...
Cutaneous rash is one of the commonest adverse events associated with lamotrigine. We assessed whether the risk is increased in patients receiving concomitant valproate therapy in a population of 103 adult patients with intractable epilepsy, who had lamotrigine added to their treatment. Of the 33 pa...
A 66-year-old woman had fever, rash, and joint pain. Physical examination revealed multiple enlarged lymph nodes. A possibility of lymphoma was considered and FDG PET/CT was performed, which demonstrated elevated FDG activity not only in many lymph nodes but also in the spleen and liver. However, adult-onset Still disease was diagnosed, and the patient responded well to therapy. PMID:22899190
Neonatal herpes simplex virus (HSV) can be a devastating illness and may be difficult to diagnose in those cases without a typical skin rash. As a result, physicians often rely on HSV polymerase chain reaction of cerebrospinal fluid to rule out HSV encephalitis. We developed a real-time polymerase c...
Environmental and breathing-zone samples were analyzed for cutting-oil mists, metal working fluids, and mineral spirits at Raytheon Missile Systems Divisions, Bristol, Tennessee in July, 1985. The evaluation was requested confidentially to investigate the occurrence of skin rashes in Machine-Department employees.
The tumorigenic potential of clofibrate, a peroxisome proliferator, was evaluated in a 26-week bioassay using CB6F1-TgHras2 (rasH2) mice carrying a human prototype c-Ha-ras gene. Clofibrate was administered to rasH2 mice orally by gavage at doses of 0 (vehicle control), 125, 250 or 500 mg/kg/day for 26 weeks. Single i.p. injection of 75 mg/kg methyl nitrosourea (MNU) was given to additional rasH2 group as positive control. CB6F1 non-Tg-rasH2 (non-Tg) mice were given either vehicle or 500 mg/kg of clofibrate. In rasH2 mice receiving clofibrate, hepatocellular adenoma was observed in males; 0 (1/15), 125 (0/15), 250 (3/15), and 500 mg/kg (3/15), but not in females. Although the trend test was positive (p<0.01), there was no dose-response and no statistical significance for hepatocellular adenoma. There was no hepatocellular adenoma in non-Tg mice. Increased incidence of neoplastic lesions, e.g. thymic lymphomas, forestomach/skin tumors were found in MNU treated mice as expected. In conclusion, the tumorigenic potential of clofibrate was equivocal in this model, as there was a weak response in the male 250 and 500 mg/kg dose groups but no dose-response. These results indicated further validation of this model as an alternative to the 2-year rodent carcinogenicity bioassay for human carcinogenic safety assessment will be needed.
The breakdown of the Argentine currency board in early 2002 produced a number of obituaries that often quite rashly declared the country?s monetary constitution since 1991 the main responsible for its recent near-catastrophic economic collapse. Contrary to such rather one-sided negative ascriptions ...
We report that eight patients from France, Italy, and Thailand had serological evidence of Rickettsia helvetica infection. The infection presented as a mild disease in the warm season and was associated with fever, headache, and myalgia but not with a cutaneous rash. R. helvetica should be suspected in patients with unexplained fever, especially following a bite from an Ixodes sp. tick. PMID:14766859
Anecdotes, both historical and recent, recount the curing of skin infections, including diaper rash, by using red soils from the Hashemite Kingdom of Jordan. Following inoculation of red soils isolated from geographically separate areas of Jordan, Micrococcus luteus and Staphylococcus aureus were ra...
Abstract: The perineal groove is a rare congenital anomaly of the perineum. We present a case of this uncommon condition that had been misinterpreted as irritant dermatitis following treatment for diaper rash. To our knowledge this is the first report of this condition is the dermatology literature.
A 26-year-old woman was affected with a maculopapular rash because of a jellyfish sting on her right leg while surfing in Indonesia. A locally-prepared liniment was applied on the affected skin. She presented with hyperpigmented linear tracks that she noted a few days later. PMID:22943277
Whipple’s disease is a multisystem infectious disease caused by the bacterium Tropheryma whippelii. A case with an unusual presentation is reported. A 66-year-old man presented with a febrile vasculitic rash on his forearms. An extensive rheumatological, hematological and infectious workup gave nega...
We report the first known case of both Noonan syndrome and Whipple’s disease occurring in the same patient. A 36-year-old female with history of Noonan syndrome developed fatigue, anorexia, arthritis of the knees and hands with a diffuse hyperpigmented rash, night sweats, and an unintentional fiftee...
A 15-month-old girl presented with rash, fever, and vesicles around the mouth that worsened after erythromycin was administered. Subsequently, she was diagnosed with toxic epidermal necrolysis. Ocular involvement was treated with repeated complete corneal, conjunctival, and lid margin coverage with amniotic membrane. She recovered with minimal ocular sequelae despite persistent systemic symptoms.
A 14 year old girl with idiopathic hypereosinophilic syndrome is described. In addition to weight loss, anaemia, amenorrhoea, general lethargy, anorexia, mouth ulcers, blisters of hands and feet, and petechial skin rash, she had features of involvement of the cardiovascular system as the major compl...
Granuloma annulare is a long-term ( chronic ) skin disease consisting of a rash with reddish bumps arranged in a circle or ring. ... Habif TP. Cutaneous manifestations of internal disease. In: Habif TP, ed. ... Pa: Mosby Elsevier;2009:chap 26. Morelli JG. Diseases of ...
Capecitabine administration has been associated with various allergic reactions including acneiform skin rash, linchenoid photosensitive eruption, exudative non healing scalp, skin reactions, pyogenic granuloma, subacute cutaneous systemic lupus erythematosus, exudative hyponychia dermatitis, and hand-foot syndrome. A patient who developed ventricular fibrillation following capecitabine-induced coronary vasospasm and necessitating cardioverter-defibrillator implantation was published recently in. PMID:22020660
We report a case of rickettsialpox from North Carolina confirmed by serologic testing. To our knowledge, this case is the first to be reported from this region of the United States. Including rickettsialpox in the evaluation of patients with eschars or vesicular rashes is likely to extend the recogn...
During May and June 2003, the first cluster of human monkeypox cases in the United States was reported. Most patients with this febrile vesicular rash illness presumably acquired the infection from prairie dogs. Monkeypox virus was demonstrated by using polymerase chain reaction in two prairie dogs ...
Cercarial dermatitis is a parasitic impasse that has worldwide distribution. The condition manifests itself as a highly pruriginous skin rash and is due to penetration of the dermis by larval stages (furcocercariae) of avian trematodes. Many species may be responsible for this disease. In Europe the...
Perigenital cutaneous schistosomiasis was diagnosed in a patient who had no previous genitourinary or gastrointestinal symptoms suggesting schistosomiasis; his only symptom was a pruritic papular rash in the perineum. Late cutaneous schistosomiasis due to deposition of ova in the dermis is rare but ...
Dental CT software program can provide reformatted cross-sectional and panoramic images that cannot be obtained with conventional axial and direct coronal CT scan. The purpose of this study is to describe the method of the technique and to identify the precise anatomy of jaw. We evaluated 13 mandibles and 7 maxillae of 15 subjects without bony disease who were being considered for endosseous dental implants. Reformatted images obtained by the use of bone algorithm performed on GE HiSpeed Advantage CT scanner were retrospectively reviewed for detailed anatomy of jaw. Anatomy related to neurovascular bundle(mandibular foramen, inferior alveolar canal, mental foramen, canal for incisive artery, nutrient canal, lingual foramen and mylohyoid groove), muscular insertion(mylohyoid line, superior and inferior genial tubercle and digastric fossa) and other anatomy(submandibular fossa, sublingual fossa, contour of alveolar process, oblique line, retromolar fossa, temporal crest and retromolar triangle) were well delineated in mandible. In maxilla, anatomy related to neurovascular bundle(greater palatine foramen and groove, nasopalatine canal and incisive foramen) and other anatomy(alveolar process, maxillary sinus and nasal fossa) were also well delineated. Reformatted images using dental CT software program provided excellent delineation of the jaw anatomy. Therefore, dental CT software program can play an important role in the preoperative assessment of mandible and maxilla for dental implants and other surgical conditions.
An 86-year-old female presented with rare bilateral chronic subdural hematomas (CSHs) of the posterior fossae which were successfully treated by surgical intervention. She had experienced mild head trauma one month before admission. She was transferred to our hospital because of consciousness disturbance and tetraparesis. Magnetic resonance (MR) imaging showed simultaneous occurrence of supratentorial and infratentorial CSHs. We tried to evacuate the CSHs of the bilateral posterior fossae because brainstem compression was markedly severe. Through bilateral burr-hole trepanations, chocolate-colored fluid, not containing clotted components, gushed out under great pressure. Postoperative course was uneventful. MR imaging revealed that the CSHs of the posterior fossae had completely disappeared and brainstem compression had also improved. The patient's neurological deficits were immediately improved after the operation. The patient was discharged one month after the operation for further rehabilitation. Trepanation and evacuation of the hematoma through the posterior fossa might be one of the therapeutic options for posterior fossa CSH, which is similar to supratentorial CSH. However, we considered that the emergency of this rare entity and the method of anesthesia were quite different from supratentorial CSH.
Differential radiologic diagnosis of cystic malformations of the posterior fossa is often difficult with conventional imaging techniques because of overlapping features of these entities. Posterior fossa cystic malformations occupy the cerebrospinal fluid (CSF) spaces. They may create secondary dynamic effects on the movements of CSF. The aim of this study was to investigate CSF flow alterations in posterior fossa cystic malformations with CSF flow MR imaging. The study included 40 patients with cystic malformations of the posterior fossa. The patients underwent cardiac-gated phase-contrast cine MR imaging. CSF flow was qualitatively evaluated using an in-plane phase-contrast sequence in the midsagittal plane. The MR images were displayed in a closed-loop cine format. Twelve of the patients had communicating arachnoid cyst, seven had non-communicating arachnoid cyst, ten had mega cisterna magna, six had Dandy-Walker malformation, two had Dandy-Walker variant, and three had Blake's pouch cyst. CSF flow MR imaging indicated the regions of no, slow or higher flow, direction of flow, and abnormal cystic fluid motion. Each malformation displayed a distinct CSF flow pattern. Phase-contrast cine MR imaging for CSF flow evaluation may be a useful adjunct to routine MR imaging in the evaluation of the cystic malformations of the posterior fossa because it can improve the specificity in differentiating such malformations. (orig.)
Abstract in portuguese É relatado o caso de uma criança de 12 anos de idade apresentando quadro de hipertensão endocraniana e síndrome cerebelar, cujos exames neurológico e neuroradiológicos foram sugestivos de neoplasia de fossa posterior. A cintilografia cerebral mostrou um quadro compatível com a existência de tumor da fossa posterior, da linha mediana, mais provavelmente meduloblastoma ou astrocitoma. Pela intervenção cirúrgica foi verificado tratar-se de cisticercose, sendo remo (more) vido um cisto do 4ºventrícuio. Os autores sugerem que em áreas geográficas com alta prevalência de neurocisticercose na população infantil a hipótese da forma pseudotumoral seja lembrada, quando da tentativa de caracterização do tipo de lesão da fossa posterior, detectada pela cintilografia cerebral. Abstract in english The case of a twelve year old child with intracerebral hypertension and cerebellar syndrome in whom the neuroradiological and neurological examinations were sugestive of posterior cranial fossa tumor is reported. The brain scan depicted the scintigraphic pattern of midline neoplasms, most likely medullo-blastoma or astrocytoma. At surgery a Cysticercus cellulosae was removed from the fourth the fourth ventricle. The authors suggest that in geographical areas with high pre (more) valence of neurocysticercosis in the infantile population the hypothesis of the pseudotumoral form of the disease be remembered when one attempts to characterize the type of neoplasms of the posterior fossa as detected by brain scan.
ABSTRACT: BACKGROUND: Chiari-like malformation (CM) and syringomyelia is a neurological disease complex with high prevalence in cavalier King Charles spaniels (CKCS). The natural progression of this disease with time has not been described. The objectives of this study were to i) determine if syringomyelia progresses with time ii) determine if features of craniocrebral morphology previously associated with CM are progressive (including caudal cranial fossa volume, caudal cranial fossa parenchymal volume, ventricular dimensions, height of the foramen magnum and degree of cerebellar herniation). A retrospective morphometric analysis was undertaken in 12 CKCS with CM for which repeat magnetic resonance images were available without surgical intervention. RESULTS: The maximal syrinx width, height of the foramen magnum, length of cerebellar herniation and caudal cranial fossa volume increased over time. Ventricular and caudal fossa parenchymal volumes were not significantly different between scans. CONCLUSIONS: The results of this study suggest that syringomyelia progresses with time. Increased caudal cranial fossa volume may be associated with active resorption of the supraoccipital bone, which has previously been found in histology specimens from adult CKCS. We hypothesise that active resorption of the supraoccipital bone occurs due to pressure from the cerebellum. These findings have important implications for our understanding of the pathogenesis and variable natural clinical progression of CM and syringomyelia in CKCS. PMID:23136935
In order to clarify the possible mechanisms underlying the inhibition of uterine tumorigenesis in rasH2 mice carrying a human prototype c-Ha-ras gene when treated with ethinylestradiol (EE), mice were given a single intraperitoneal injection of 120 mg/kg N-ethyl-N-nitrosourea (ENU), followed by 2.5 ppm EE for 6 weeks. Many genes involved in estrogen responses and cell proliferation in the uterus of rasH2 mice are activated by treatment with ENU followed by EE. These include genes associated with receptors such as estrogen receptor (ER) alpha, cell cycles such as cyclin E, cyclin dependent kinase (CDK) 4, CDK inhibitors, ubiquitin and smad3, and growth factors such as epidermal growth factor (EGF) receptor, transforming growth factor (TGF) beta, TGF beta receptor and insulin-like growth factor (IGF). In this study, the ENU+EE treated rasH2 mice demonstrated acceleration of estrogen decomposition and down-regulation of the expression of ER alpha. TGF beta, serine/threonine kinase and smad3, which are downstream of the TGF beta signaling pathway, were also down-regulated, indicating signal values such as CDK4 were down-regulated in the ENU+EE treated rasH2 mice. Ubiquitin which indicates CDK inhibitory metabolism was also down-regulated. Finally, several genes involved in growth factors such as EGF receptor, TGF beta receptor and IGF were also down-regulated. On the other hand, the ENU+EE treated ICR mice showed deceleration of estrogen decomposition and up-regulation of the expression of ER alpha, down-regulation of TGF beta, serine/threonine kinase, smad3, CDK4, ubiquitin, EGF receptor, TGF beta receptor and IGF, indicating that these genes appear to act as stimulants of cell proliferation and carcinogenesis. Therefore, we consider that these genes are key genes which are strongly involved in the inhibition of uterine carcinogenesis in ENU-initiated rasH2 mice treated with EE.
Smallpox preparedness research has led to development of antiviral therapies for treatment of serious orthopoxvirus infections. Monkeypox virus is an emerging, zoonotic orthopoxvirus which can cause severe and transmissible disease in humans, generating concerns for public health. Monkeypox virus infection results in a systemic, febrile-rash illness closely resembling smallpox. Currently, there are no small-molecule antiviral therapeutics approved to treat orthopoxvirus infections of humans. The prairie dog, using monkeypox virus as a challenge virus, has provided a valuable nonhuman animal model in which monkeypox virus infection closely resembles human systemic orthopoxvirus illness. Here, we assess the efficacy of the antiorthopoxvirus compound ST-246 in prairie dogs against a monkeypox virus challenge of 65 times the 50% lethal dose (LD(50)). Animals were infected intranasally and administered ST-246 for 14 days, beginning on days 0, 3, or after rash onset. Swab and blood samples were collected every 2 days and analyzed for presence of viral DNA by real-time PCR and for viable virus by tissue culture. Seventy-five percent of infected animals that received vehicle alone succumbed to infection. One hundred percent of animals that received ST-246 survived challenge, and animals that received treatment before symptom onset remained largely asymptomatic. Viable virus and viral DNA were undetected or at greatly reduced levels in animals that began treatment on 0 or 3 days postinfection, compared to control animals or animals treated post-rash onset. Animals treated after rash onset manifested illness, but all recovered. Our results indicate that ST-246 can be used therapeutically, following onset of rash illness, to treat systemic orthopoxvirus infections. PMID:21697474
PurposeTo investigate dose-volume consequences of inclusion of the seminal vesicle (SV) bed in the clinical target volume (CTV) for the rectum and bladder using biological response indices in postprostatectomy patients receiving intensity-modulated radiotherapy (IMRT). Methods and MaterialsWe studied 10 consecutive patients who underwent prostatectomy for prostate cancer and subsequently received adjuvant or salvage RT to the prostate fossa. The CTV to planning target volume (PTV) expansion was 7 mm, except posterior expansion, which was 5 mm. Two IMRT plans were generated for each patient, including either the prostate fossa alone or the prostate fossa with the SV bed, but identical in all other aspects. Prescription dose was 68.4 Gy in 1.8-Gy fractions prescribed to ?95% PTV. ResultsW...
Background: Transesophageal (TEE) and intracardiac (ICE) echocardiography are commonly used to guide percutaneous patent foramen ovale (PFO) closure. The study aim was to perform a head-to-head comparison between TEE and rotational ICE echocardiography in the measurement of the fossa ovalis and device selection. Methods: In 45 patients with cryptogenic stroke or peripheral embolism and PFO with large right-to-left shunt, fossa ovalis dimensions were assessed preoperatively by TEE and intraoperatively by rotational ICE. The Amplatzer devices, deployed on the basis of ICE, were compared with those that would have been selected by TEE. Results: A good correlation between TEE and rotational ICE was observed for both longitudinal and transverse fossa ovalis dimensions (TEE four-chamber vs. ICE ...
Abstract in portuguese Os autores relatam caso de meningeoma de fossa posterior com projeção extracraniana em criança de 3 anos de idade, submetido a terapêutica cirúrgica com boa evolução e remissão completa dos sinais e sintomas neurológicos apresentados. A raridade do tipo e localização do tumor nessa faixa etária justificam a apresentação e registro do caso. Abstract in english A case of posterior fossa meningeoma with extracranial projection in a three years old female child is reported. The rarity of the process, its localization and the age group committed are emphasized. The radiological findings first suggesting an aneurismatic bone cyst like are commented. The surgical treatment with a posterior fossa approach and good results observed as well as the rarity of this pathology justify the report.
Removal of an impacted superior third molar is usually a simple and uncomplicated procedure for an Oral and Maxillofacial Surgeon. Nevertheless, complications are possible and include infection, facial swallowing, trismus, wound dehiscence, root fracture or even orosinusal fistula. Iatrogenic displacement into the infratemporal fossa is frequently mentioned but rarely reported. This anatomical fossa includes several important structures such as the internal maxillary artery, the venous pterygoid plexus, the sphenopalatine nerve, the coronoid process of the mandible and the pterygoid muscles. Recommended treatment includes immediate surgical removal if possible or initial observation and secondary removal, as necessary, because of infection, limited mandibular movement, inability to extract the tooth, or the patient's psychological unease. Sometimes, the displaced tooth may spontaneously migrate inferiorly and becomes accessible intraorally. This report describes the location and secondary surgical removal of a left maxillary third molar displaced into the infratemporal fossa, two weeks after first attempt at extraction. PMID:20038889
Anterior cranial fossa dural arteriovenous fistulae (DAVFs) are very rare and the bleeding rate is very high, especially in the presence of leptomeningeal draining vein and aneurysmal varix formation. A 85-year-old male patient presented with subdural hematoma (SDH). Magnetic resonance image (MRI) and transfemoral carotid angiography (TFCA) disclosed DAVF at the anterior cranial fossa with bilateral arterial feeders and leptomeningeal draining vein with varix formation. The lesion was treated by simple ligation of pial connecting vein using low frontal craniotomy. In comparison with DAVFs of the other sites, the anterior cranial fossa DAVF is difficult to manage by endovascular treatment due to not only the difficulty of transvenous access but the risk of visual impairment when using transarterial route. Surgical ligation of pial connecting vein is feasible and effective treatment.
AbstractBackground Posterior fossa syndrome (PFS) is defined as the temporary and complete loss of speech after posterior fossa surgery. The goal of this study was to identify incidence and risk factors for PFS and to determine accompanying neurobehavioral and psychologic problems. Procedure Between May 2007 and April 2009, children with brain tumors having posterior fossa surgery were evaluated neurologically and psychologically in preoperative and postoperative period. Results PFS developed in 9 patients among 36 (25%) included in the study. Mutism continued for 120 days in one patient. Histopathological diagnosis (P = 0.05), location of the tumor (P = 0.05) and socioeconomic level of the family (P = 0.06) gave the significant results in relation with the PFS by univariate analyses. In m...
Between 1970 and 1985, 29 patients were postoperatively irradiated for medulloblastoma. Eight out of them received only a local irradiation and 21 a complete CNS irradiation. The posterior fossa was saturated up to a dose of 45 to 49 Gy in nine patients and 50 to 55 Gy in twelve patients. The patients treated by complete CNS irradiation show a three-year survival rate of 47% and a five-year survival rate of 40%. A nonsignificant increase of the three-year survival rate is found in patients whose posterior fossa was exposed to a higher radiation dose. Eleven recurrences were observed, and the posterior fossa was involved in seven out of these cases. Four recurrences confined to the spine were found after a dose of 20 to 30 Gy. Remote metastases, preferentially with a skeletal site, were formed in three out of 29 cases.
Background context Spinal lipomas not associated with spinal dysraphism are rare entities. Further, large medullary lipomas with intracranial extension are occasionally described. Most of the intradural lipomas are subpial and not really intramedullary. Purpose Clinicians may be made aware of such a rare entity and its presentation. Study design/setting An extremely rare case of medullary lipoma extending into posterior fossa is described in an adult, not associated with spinal dysraphism. Methods A young male presented with high cord myelopathy in the form of spastic quadriparesis. Radiological investigations revealed dorsally placed intramedullary lipoma extending into posterior fossa. Results Surgical excision of tumor provided satisfactory resolution of symptoms. Conclusions Medullary ...
Vaginal masses can have numerous different presentations and causes. Physicians can often make an empiric diagnosis of these masses on the basis of their clinical presentation and location. Most of these diagnoses are correct, with the rare exception of the occasional urethral diverticulum or hydrocele. In this case report, we discuss the initial diagnosis of a suspected infected Bartholin gland duct cyst that was in fact a 10 × 8 × 7.5-cm epithelial inclusion cyst that extended through the ischiorectal fossa and down to the gluteal region, requiring extensive dissection. Also presented is a detailed description of the anatomical landmarks encountered at dissection through the vaginal sidewall and ischiorectal fossa. PMID:22935309
Vaginal masses can have numerous different presentations and causes. Physicians can often make an empiric diagnosis of these masses on the basis of their clinical presentation and location. Most of these diagnoses are correct, with the rare exception of the occasional urethral diverticulum or hydrocele. In this case report, we discuss the initial diagnosis of a suspected infected Bartholin gland duct cyst that was in fact a 10 x 8 x 7.5-cm epithelial inclusion cyst that extended through the ischiorectal fossa and down to the gluteal region, requiring extensive dissection. Also presented is a detailed description of the anatomical landmarks encountered at dissection through the vaginal sidewall and ischiorectal fossa.
Multiple sclerosis patients sometimes complain of vertigo as one of their symptoms. We experienced a case in which vertigo was seen as the chief complaint. MRI and neurootological examinations led to the diagnosis that the vertigo was caused by recurrent multiple sclerosis lesions of the posterior cranial fossa. We then considered five earlier multiple sclerosis patients who had vertigo. Their pure tone audiogram and caloric tests were almost normal. However, neurootological examinations ETT, OKP and gravicorder showed abnormalities. Therefore, in addition to MRI T2 and T2 FLAIR image examinations, neurootological examinations are valuable for diagnosis, especially in order to detect posterior cranial fossa lesions.
A 14-year-old boy presented with a very rare meningioma in the posterior cranial fossa without dural attachment. Magnetic resonance imaging revealed a 3-cm, well-circumscribed, heterogeneously enhanced, round mass without dural tail sign in the right side of the posterior fossa. Right vertebral angiography revealed very faint tumor staining supplied by the right posterior inferior cerebellar artery. Total removal of the tumor was performed. Intraoperatively, the mass exhibited no attachment to the dura mater, cerebellar parenchyma, or choroid plexus, but was firmly attached to the arachnoid tissue near the foramen of Luschka. Histological and immunohistochemical studies established the diagnosis of meningothelial meningioma (World Health Organization grade I).
AbstractObjective: To review the clinical presentation, surgical techniques, and outcomes of the transmastoid extradural-intracranial (TMEDIC) approach for the treatment of transtemporal meningoencephalocele. Hypothesis: The TMEDIC is a safe and effective approach to repair meningoencephalocele originating from the middle or posterior cranial fossa. Study Design: Retrospective chart review. Setting: Academic neurotologic tertiary referral center. Patients: Thirty-one consecutive patients diagnosed with transpetrous meningo(encephalo)cele, with or without cerebrospinal fluid leak, between January of 2003 and October of 2010. Intervention: TMEDIC approach for repairing herniated neural tissue through the tegmen or posterior fossa plate using the combination of autologous cartilage, fascia, a...
Introduction: Pseudomeningocele is a relatively frequent com-plication after posterior fossa surgery which is usually not clinically significant. Very rarely however, an acute posterior fossa syndrome can arise as a result of tension pseudomeningocele. Material and Methods: We present two cases of spontaneous intracerebellar migration of a pseudomeningocele causing progressive cerebellar dysfunction. The first case describes pseudomeningocele formation after resection of a cerebellar midline metastasis of non-small cell lung cancer. Progressive cerebellar symptoms revealed a tension pseudomeningocele for which marsupialisation was performed. The second case describes a patient with progressive cerebellar dysfunction caused by a recently developed tension pseudomeningocele more then forty y...
The mobile meniscal bearing of unicompartmental knee arthroplasty is completely free moving, and dislocation of this bearing is a major concern for all mobile-bearing designs. Most dislocations are located in the intracapsular area; however, posterior dislocation of the polyethylene bearing to an extra-articular area of the knee after unicompartmental arthroplasty has not been previously reported. During a revision surgery, separate incision was necessary to remove a dislocated meniscal bearing in the popliteal fossa. The authors present a case of incarceration of a dislocated mobile bearing to the popliteal fossa after unicompartmental knee arthroplasty that was missed during initial diagnosis.
A 21-year-old female presented with an unusual case of posterior fossa arteriovenous malformation (AVM) associated with ipsilateral persistent primitive trigeminal artery (PPTA), manifesting as intraparenchymal hemorrhage involving both the brain stem and the left cerebellar hemisphere. The presenting symptoms were compatible with Wallenberg’s syndrome and Foville’s syndrome on the left side. She was initially treated conservatively, and subsequently with transarterial embolization followed by stereotactic radiosurgery. This case combined the rare association of posterior fossa AVM and PPTA, with the clinical presentation of intraparenchymal hemorrhage causing both Wallenberg’s syndrome and Foville’s syndrome.
Twenty three patients of maxillary cancer were examined by computed tomography and conventional frontal tomography, and their diagnostic accuracy was investigated. Accuracy of computed tomography for detection of bone destruction is almost equal to that of tomography, though superior to tomography in recognition of tumor extent, at both pterygopalatine fossa and infratemporal fossa. We must be careful in evaluation of invasion to the ethmoid sinus because of many false positives. The computed tomographic images are useful for management of maxillary cancer, not only in treatment planning but also in follow up examination after combination therapy.
The fine structural details of the spermatozoon of the round goby are presented for the first time in this study. Scanning and transmission electron microscopic examination of testis reveals an anacrosomal spermatozoon with a slightly elongate head and uniformly compacted chromatin. The midpiece contains a single, spherical mitochondrion. Two perpendicularly oriented centrioles lie in a deep, eccentric nuclear fossa with no regularly observed connection to the nucleus. The flagellum develops bilateral fins soon after emerging from the fossa; each extends approximately 1 A?m from the axoneme and persists nearly the length of the flagellum.
Complete surgical resection of intra-axial hypervascular tumors located in the posterior fossa, in particular hemangioblastomas, may be challenging due to tumor location, mass effect and excessive bleeding. Embolization of these lesions can be done preoperatively or as a palliative measure in patients who are not surgical candidates. Preoperative embolization may reduce intraoperative blood loss, shorten surgical time and increase the chance of a complete resection. However, the safety and effectiveness of this procedure is still a matter of debate. Three cases of intra-axial hypervascular tumors in the posterior fossa (two confirmed hemangioblastomas) that were embolized using a non-adhesive liquid embolic agent (Onyx) are reported. PMID:22266792
The posterior fossa syndrome (PFS) consists of transient cerebellar mutism, cognitive symptoms and neurobehavioural abnormalities that typically develop in children following posterior fossa tumour resection. Although PFS has been documented in more than 350 paediatric cases, reports of adult patients with a vascular aetiology are extremely rare. In addition, the pathophysiological substrate of the syndrome remains unclear. We report an adult patient with PFS after surgical evacuation of a cerebellar bleeding. After 45?days of (akinetic) mutism, the patient?s cognitive and behavioural profile closely resembled the ?cerebellar cognitive?affective syndrome?. A quantified SPECT study showed perfusional deficits in the anatomoclinically suspected supratentorial areas, subserving language dynam...
Twenty-three patients with previously treated medulloblastoma had brain scintigrams during evaluation for recurrent or metastatic tumor. The scintigrams revealed posterior fossa recurrence in 15 patients and supratentorial metastases in 9; only 1 of the latter was clinically suspected. Two subdural hematomas and one calvarial metastasis were also detected. Comparison with other diagnostic evidence shows agreement in 13 out of 14 cases (93 percent) for posterior fossa recurrence and /sup 8///sub 10/ (80 percent) for supratentiorial masses. Brain scintigraphy appears to be a sensitive and specific test for the detection of recurrence and metastasis in patients with treated medulloblastoma.
Medulloblastoma is the most common malignant central nervous system tumor in pediatric patients and the most common primary tumor in the posterior fossa in children, most manifest in patients 5-12 years of age. Clinical features are mainly characterized by intracranial hypertension and ataxia. The authors present a case of medulloblastoma with extensive nodularity, a rare variant which affects younger age usually under three years, with more favorable prognosis. It is typically a cystic lesion in the posterior fossa with solid nodular components that enhance after contrast, like 'bunch of grapes' clusters. Preoperative diagnosis could be suggested by this finding. (author)
Abstract in portuguese Os autores descrevem episódios de mutismo após cirurgia para tumores da fossa posterior em pacientes jovens. São apresentados dois casos e é feita análise da ausência de expressão verbal que estabeleceu após a cirurgia. Também é feita análise do mutismo do ponto de vista de suas conotações neurológicas e psicológicas, ao mesmo tempo em que é revista a literatura sobre o assunto. Abstract in english The authors present two cases of mutism after posterior fossa surgery. Two patients aged 16 and 5 years old respectively with astrocytoma and medulloblastoma, developed mutism after the operation. Topographic aspects of the condition are discussed and its neurological expression.
A 55-year-old man present with a case of ganglioneuroma manifesting as sudden onset of severe headache. T1-weighted magnetic resonance imaging demonstrated a heterogeneously enhanced mass (3 × 3 × 2.5 cm) in the left middle cranial fossa compressing the left cavernous sinus. The tumor was totally removed through a frontozygomatic approach. The histological diagnosis was ganglioneuroma originating from the second division of the trigeminal nerve in the middle cranial fossa. Ganglioneuroma can occur wherever ganglion cells exist, but ganglioneuroma originating from the trigeminal nerve is rare, with only two cases reported.
Abstract in spanish El nervio maxilar puede ser bloqueado en la fosa pterigopalatina, ingresando desde la cavidad oral vía canal palatino mayor. El objetivo de este estudio fue analizar el volumen de la fosa y su relación con los índices cefálico y facial superior. Se utilizaron 71 cráneos humanos adultos, sin distinción de sexo. Se determinó el volumen de la fosa pterigopalatina y los índices cefálico y facial superior. Mediante una prueba t (p (more) volumen entre los tipos cefálicos y faciales. El volumen medio de lafosafue de 1.2 mi (DS 0.297), no se encontraron diferencias de acuerdo al tipo cefálico o facial. Abstract in english The maxilary nerve can be block in the pterygopalatine fossa, entering from oral cavity via greater palatine canal. The aim of this study was to analyse the volume of the pterygopalatine fossa and its relationship with upper facial height and cephalic indexes. In 71 human adults skulls, without sex distinction, was determined the volume of the pterygopalatine fossa and cephalic and upper facial height indexes. Through a t test (p (more) etween cephalic and facial types. The average volume of the pterygopalatine fossa was 1.2 mi (DS 0.297), were not found differences according to the cephalic or facial type.
BACKGROUND:: Post-operative hydrocephalus is common in patients after resection of a posterior fossa tumor, with up to 25% of patients requiring permanent cerebrospinal fluid (CSF) diversion in the form of ventricular shunting or ventriculocisternostomy in some series. Prophylactic ventriculocisternostomy has been described with success in this patient population to prevent post-operative hydrocephalus. OBJECTIVE:: To define the technique of microsurgical, retrograde third ventriculostomy from the posterior fossa. Methods: Operative technique description; report of a single patient with four year follow-up. RESULTS:: We describe the case of a 32-year-old woman who presented with a large cerebellopontine angle epidermoid tumor. She underwent a simultaneous lesion resection and third ventriculocisternostomy by accessing the interpeduncular cistern through a suboccipital posterior fossa approach and then making an incision through the tuber cinereum to access the third ventricle under direct vision. CONCLUSION:: Retrograde third ventriculostomy may be useful in the surgical treatment of patients already undergoing operations for large posterior fossa lesions who have a high likelihood of requiring permanent CSF diversion and in whom exposure of the interpeduncular cistern is available. PMID:23037821
Abstract in spanish Se observó la correlación entre la profundidad de la fosa mandibular con la condición dental y la edad en los humanos. 120 fosas mandibulares frescas de hombres fueron medidas desde la zona más profunda de la fosa a una línea horizontal de referencia. Las muestras fueron clasificadas de acuerdo a la edad y el estado dental (dentados, parcialmente dentados y desdentados en total) empleando un análisis multivariado. La edad media de los sujetos fue de 41,1 (20-85). Hu (more) bieron más personas parcialmente dentadas (59,16%) que los dentadas (30%) o desdentadas (10,83%). La profundidad media de la fosa media fue de 6,9mm (6.6 a 7.1 mm, IC 95%) la cual disminuyó significativamente con el aumento de edad y el deterioro de la salud dental (p Abstract in english A mandibular fossa depth correlation with dental condition and age in humans. 120 fresh male mandibular fossas were measured from the deepest area of the fossa to a horizontal reference line. The samples were classified according to age and dental state (dentate, partially dentate and totally edentulous) and a multivariate analysis was employed. Subjects average age was 41.1 (20-85). There were more partially dentate individuals (59.16%) than dentate (30%) or edentulous o (more) nes (10.83%). Average fossa depth was 6.9 mm (6.6-7.1 mm 95%CI) which significantly decreased with increased age and dental health deterioration (p
Two adult patients with rhabdomyosarcoma of the infratemporal fossa region were evaluated by computed tomography and magnetic resonance imaging both before and after treatment. Successful treatment accompanied by reduction of the tumor mass as a result of chemotherapy was demonstrated in one patient...
Extensive wind-swept plains of the Medusae Fossae formation on Mars. This northern subframe image, frame 3104, is of a 3.0 x 4.7 km area centered near 2.4 degrees north, 163.8 degrees west.Figure caption from Science Magazine
The team proposes an indirect method to quantify the wind effects on Mars’ surface. We look to measure the dimensions of yardangs, to determine whether characteristics of aeolian processes are related to the characteristics of yardangs in the Medusa Fossae region.
Extensive wind-swept plains of the Medusae Fossae formation on Mars. This southern subframe image, frame 3104, is of a 3.0 x 4.7 km area centered near 2.0 degrees north, 163.8 degrees west.Figure caption from Science Magazine
This report summarizes the status of a mapping project supported by NASA grant NNX07AP42G, funding for which became available on July 18, focusing on the mapping of the Medusae Fossae Formation (MFF) on Mars. The report also briefly discusses the status of maps of Venus and Ascraeus Mons, begun under previous NASA grants but which are still in progress.
Adenoid cystic carcinoma of the hard or soft palate is a slow-growing, insidious disease with a tendency to spread via a perineural mechanism along the palatine branches of the maxillary division of the trigeminal nerve. Such spread may present first as a tumor in the pterygopalatine fossa or cavern...
Nov 8, 2012 ... The linear depression in today's VIS image is a volcanic vent in the lava plains ... Channels dissect the complex region of Acheron Fossae, located north of ... The 2002 Winter Olympics were hosted by Salt Lake City at several ...
To describe the normal MR appearance after cholecystectomy and the findings in patients with postoperative complications using fast pulse sequences in abdominal MR imaging. Material and methods: In a prospective study of 119 patients, 64 were examined with MR after cholecystectomy. In total, 56 patients with uncomplicated cholecystectomy were examined with MR 1-5 days (mean 1.6 days) after cholecystectomy. Nine patients had an abdominal postoperative complication and 8 of these were examined with MR after the complication commenced 1-12 days after the cholecystectomy. Results: Oedema in the gallbladder fossa was the only finding in 39 patients (61%), all with uneventful recovery. Small fluid collections in an area consistent with the gallbladder fossa were seen in 9/64 (14%) patients, of which 3 had surgical complications: 1 bleeding and 2 bile duct leakage. Twenty-two (34%) patients had small locally situated fluid collections adjacent to the liver, 14 were uneventful and 8 showed postoperative surgical complications. Seven patients had fluid in the rest of the abdomen of which 5 had surgical complications; 4 due to bile duct leakage and 1 acute pancreatitis. One patient had a postoperative bleeding not seen on MR images. Conclusion: MR is very sensitive in detecting fluid collections. Early MR findings following cholecystectomy are normally only subtle changes, mainly in the gallbladder fossa. Fluid collections diagnosed elsewhere than in the gallbladder fossa usually indicate a surgical complication and a surgical complication is unlikely if MR fails to show a fluid collection.
The use and benefits of a corneal shield specifically designed for use in cerebral angiography are discussed. It is shown that up to 70% reduction in dose to the cornea on the ipsilateral side may be achieved without loss of diagnostic information unless the suspected pathology lies within the eye, the orbit or the anterior fossa of the temporal lobe.
We report the case of a 55 year old man who presented as Pancoast's syndrome associated with a left sided Horner's syndrome, a mass in the left supraclavicular fossa and marked weakness with wasting of the left arm consistent with a left sided brachial plexus lesion. Biopsy revealed the typical feat...
Pituitary abscess is a rare condition of the pituitary gland. We report MR imaging findings in two cases of surgically-confirmed pituitary abscess occurring in women aged 39 and 28. In both a peripheral rim enhancing lesion, similar to abscesses in other areas of brain, was seen in the pituitary fossa.
Primary cerebral rhabdomyosarcomas are very rare and malignant tumors that occur predominantly in the posterior fossa of pediatric patients. We report a rare case of primary cerebral rhabdomyosarcoma located in the supratentorial compartment of a 51 year-old woman together with a review of the perti...
The ilioinguinal nerve entrapment syndrome is an abdominal muscular pain syndrome, characterized by the clinical triad of muscular type iliac fossa pain with a characteristic radiation pattern, an altered sensory perception in the ilioinguinal nerve cutaneous innervation area, and a well-circumscrib...
Three-dimensional (3D) computed tomographic (CT) reconstructions were studied retrospectively in 14 patients with skull base fractures. Our aim was to assess the clarity of visualisation and pattern of these fractures. The reformations were obtained from 3 mm thick two-dimensional (2D) CT images. The 2D data stored on optical discs were retrieved and reformatted using the scanner`s software. The 3D technique could demonstrate the presence of fractures as well as 2D images. It was of special value in defining the depth and extent of fractures in the floor of the cranial fossae. Undisplaced and displaced fractures could both be demonstrated. Fractures in the anterior fossa run diagonally towards the midline and then cross the cribriform plate of the ethmoid bone. Fractures of the middle fossa run obliquely anteroposterior. Fractures in the lamina papyracea and cribriform plate were difficult to reconstruct due to the the thinness of these bones and threshold definitions. The volume of the 3D block determines the angles suitable for viewing the fractures. In spite of present technical difficulties, the 3D images are of greater anatomical and diagnostic value, particularly in anterior fossa fractures. There is no additional radiation risk to the patient, since reconstructions are made from routine 2D images. (orig.)
Pleomorphic lipoma is a benign adipocytic tumor, commonly located in the shoulder and posterior neck region. The presence of bizarre, hyperchromatic stromal cells along with multinucleated giant cells often poses difficulty in diagnosis, especially when it arises at an unusual site like tonsillar fossa. PMID:15025314
Four cases with osteonecrosis of the trochlea after open reduction and internal fixation of a fracture involving both the medial and lateral columns of the distal humerus above the base of the olecranon fossa (a bicolumnar fracture of the distal humerus) are reported to bring attention to this complication.
The use of bony landmarks can be helpful in performing an ultrasound study of the elbow. We discuss bony landmarks that can be used for evaluation of the common extensor tendon, ulnar collateral ligament and common flexor tendon, coronoid and olecranon fossa, ulnar nerve, and biceps tendon. We discuss bony landmarks for each of these structures.
The use of bony landmarks can be helpful in performing an ultrasound study of the elbow. We discuss bony landmarks that can be used for evaluation of the common extensor tendon, ulnar collateral ligament and common flexor tendon, coronoid and olecranon fossa, ulnar nerve, and biceps tendon. We discuss bony landmarks for each of these structures. PMID:21353752
which were present only as meristems; this can result, as is well known, by various extrinsic ...... then are provided with a vertex fossa on the apical extremity (cf. Fig. .... length cleavate of the shoot parallel towards the surface so that now only 2 ...
Abstract The Medusae Fossae Formation (MFF) is an extensive deposit (2.2 x 106 km2, Bradley et al., (2002)) of wind-eroded material of widely debated origin, which unconformably overlies a considerable area of the crustal dichotomy boundary on Mars. The MFF shows a variety of layering patter...
Arachnoiditis in the posterior fossa is not a rare disorder in China. Eighty-two cases seen in a three year period were studied with reference to symptomatology, aetiology and treatment. The presentation was contrasted with that of increased intracranial pressure caused by tumour. The efficacy of tr...
A ease of a persistent sciatic artery in a 60-year-old Japanese man is reported. The right persistent sciatic artery (5 mm in diameter) was joined to the internal iliac artery proximally and to the popliteal artery distally. The terminal vessel of the femoral artery (3 mm in diameter) was connected to the sciatic artery at the popliteal fossa.
Mature teratoma of the posterior cranial fossa in adults is extremely rare. We report a particularly rare case of medio-lateral cerebellar mature teratoma that became symptomatic in a middle-aged man. The CT revealed the lesion of heterogeneous density with calcifications in the solid medial portion...
Posterior fossa dural arteriovenous fistulae in children are rare lesions that are difficult to treat effectively. We report a case of a 2-year-old girl with such a fistula, who presented clinically with progressive neurological deficit. The lesion was treated by endovascular occlusion, resulting in radiological and clinical cure. PMID:11734988
Pial arteriovenous fistulas (pAVF) of the posterior fossa are rare and may present with symptoms secondary to mass effect, venous hypertension or hemorrhage, among others. A case is presented of a previously healthy 2-year-old boy with neurological deficit arising from pAVF of the posteroinferior cerebellar artery. The pAVF was successfully treated with endovascular occlusion. PMID:21990831
Determining the location of pertinent anatomic structures (ie, the internal auditory canal [IAC]) in middle cranial fossa surgery is commonly based on indirect inferences from bony landmarks. Several methods have been proposed for identification of the IAC, each using bony landmarks coupled with geo...
The halfmoon-sign is described. It consists of typically shaped fragments seen on the lateral view of the elbow in the area around the fossa radialis. With rare exceptions the halfmoon-sign is indicative of a fracture of the distal humerus in the coronal plane, mostly fractures of the capitulum humeri.
Recently, the ultrasonic activated scalpel (the Harmonic Scalpel, HS) has been introduced in laparoscopic surgery. We have applied the HS in debulking the tumor in the posterior fossa and concluded that this is useful in acoustic neuroma surgery. Fifteen patients with a tumor extending more than 20 ...
The signs of acoustic nerve neuronomas in the light of computerized-tomography findings are described. Direct and indirect signs suggesting presence of a tumour differentiating neurinoma against other tumours of the posterior cranial fossa are discussed. Four types of acoustic neurinomas are differentiated according to their reaction to the administered contrast medium.
Intracranial schwannomas preferentially arise from the vestibular branch of the eighth nerve, and rarely from the trigeminal nerve, facial nerve, and lower cranial nerves. Anterior cranial fossa schwannomas are extremely uncommon and few details about them have been reported. The patient was a 39-ye...
During a retrosigmoid (or combined retrolabyrinthine-retrosigmoid) approach to the posterior fossa for vestibular neurectomy or removal of small acoustic neuromas, a white dural fold is a consistent landmark to cranial nerves VII through XII. This fold of dura appears as a white linear structure ext...
Focal gallbladder tenderness is the most important physical finding in suspected acute cholecystitis. We describe a technique using palpation of the abdomen with the placement of a radioactive marker on the point of maximum tenderness. Correlation of the marked area to the location of the gallbladder fossa is made. This integration of palpation and scintigraphy might enhance the cholescintigraphic diagnosis of acute cholecystitis.
A 20-day-old female neonate presented with an immature teratoma in the midline posterior fossa. The tumor was totally removed but the patient died of pneumonia. Teratoma is a rare tumor, but very difficult to treat as the patients tend to be young, and the outcome is very poor.
The aim is to prospectively assess early neurocognitive outcome of children who developed cerebellar mutism syndrome (CMS) following surgical resection of a posterior fossa embryonal tumor, compared with carefully matched control patients. Children who were enrolled on an ongoing IRB-approved protoc...
Medulloblastoma is the most common pediatric posterior fossa malignancy, with a 5-year overall survival of only 60% and many survivors experiencing treatment-related morbidity secondary to current therapeutic regimens. With an improved understanding of the molecular basis for this disease, the oppor...
Medulloblastoma, a cancer of the posterior fossa, is the most common malignant brain tumor in children. Although 80% of patients with average-risk medulloblastoma are cured, their quality of life is often compromised by treatment-related side effects. Recently, molecular and genomic studies have sho...
Isolated, well-differentiated ectopic cerebellar tissue is extremely rare, with only eight cases in the literature. We describe a unique case of histopathologically proven ectopic cerebellar tissue presenting as a discrete extra-axial mass in the posterior cranial fossa. We describe the clinical, CT and MRI findings, as well as the surgical and histopathological findings and review the relevant literature. PMID:22573210
Isolated, well-differentiated ectopic cerebellar tissue is extremely rare, with only eight cases in the literature. We describe a unique case of histopathologically proven ectopic cerebellar tissue presenting as a discrete extra-axial mass in the posterior cranial fossa. We describe the clinical, CT and MRI findings, as well as the surgical and histopathological findings and review the relevant literature.
Abstract Patients having a generalised rash with severe liver dysfunction associated with exposure to trichloroethylene (TCE) have been reported mainly in Asian countries. However, no case has been reported in Japan since the 1990s. Here, we describe a case of hypersensitivity syndrome (HS) caused by TCE in a 30-year-old Japanese man. The patient developed a rash, fever and liver dysfunction 21 days after he had been exposed to TCE at his workplace. Serum human herpesvirus (HHV)-6 and cytomegalovirus (CMV) DNA were detected 4 and 7 weeks, respectively, after the onset; the IgG antibody titres to HHV-6 and CMV were significantly elevated 6 and 9 weeks, respectively, after the onset. Patch testing was positive for the metabolites of TCE (i.e. trichloroethanol, trichloroacetic acid and chlora...
Summary Background Drug-induced hypersensitivity syndrome (DIHS) is an adverse reaction with clinical signs of fever, rash and internal organ involvement. In the vast majority of patients in Japan, the causative drugs for DIHS are limited to the following eight: carbamazepine, phenytoin, phenobarbital, zonisamide, mexiletine, dapsone, salazosulfapyridine and allopurinol. The association of human herpesvirus (HHV)-6 reactivation with DIHS has been reported by various groups. Objectives To confirm the relationship between the flaring and severity of DIHS and HHV-6 reactivation. Methods We evaluated 100 patients with drug rash and systemic symptom(s) caused by the drugs associated with DIHS. HHV-6 reactivation was examined by serological antibody assay and quantitative real-time polymerase ch...
Pertuzumab is a novel humanized monoclonal antibody that blocks human epidermal growth factor receptor 2 (HER2) dimerization. It was recently approved by the US FDA for use in combination with trastuzumab and docetaxel for patients with HER2-positive metastatic breast cancer who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease. Rash is inconsistently reported as a common adverse event in most clinical trials of pertuzumab, at varying incidences. In this study, we have investigated the overall incidence and risk of rash with pertuzumab. Relevant studies were identified from the PubMed database (1966?2012), abstracts presented at the American Society of Clinical Oncology annual conference (2004?2011), and Web of Science database (1998?2012). Eligible studies w...
DRESS syndrome is a life-threatening adverse reaction characterized by skin rashes, fever, leukocytosis with eosinophilia or atypical lymphocytosis, lymph node enlargement, and liver or renal dysfunctions. DRESS syndrome related to valproic acid use is very rarely observed. We present a case of DRESS syndrome induced by sodium valproate, which developed and progressed fatally in a brucellosis patient with a positive c-ANCA test. A 19-year-old female patient presented with fever, cough, jaundice, and rash all over her body. Brucella Coombs test was positive at 1:1280 titers, and the Rose Bengal test was also positive. The involuntary movements were thought to be due to chorea, and the patient was started on sodium valproate 500 mg 2*1, as well as streptomycin 1?g flk 1*1 and tetradox capsul...
A 26-year-old nurse presented with a three-day history of sudden onset of pyrexia of 39 °C, malaise, and a patchy maculopapular rash, after returning from a monthlong work in Senegal. A tourniquet was applied to help locate the vein for diagnostic blood sampling. After the procedure, a petechial rash erupted with a demarcation line below the level of the tourniquet. A diagnostic test for dengue fever was performed and confirmed by the polymerase chain reaction (PCR) to be positive for serotype DEN-1. The tourniquet test is performed by inflating a blood pressure cuff tied on the upper arm to a point midway between systolic and diastolic blood pressure for five minutes. The test is considered positive when there are 20 or more petechiae per square inch (6.25 cm(2)) on the forearm, and is one of several clinical parameters considered by the World Health Organization to be important in the diagnosis of dengue fever. PMID:22886461
Summary Background Acute and chronic graft-versus-host disease (GVHD) continues to be a major limitation to successful haematopoietic stem cell transplantation. If experimental studies and clinical observations could partially elucidate the pathophysiology of acute GVHD, the biology of chronic GVHD is still much less well understood. Objectives The aim of this study is to describe a peculiar photoinduced rash which triggered acute and then chronic lesions of GVHD in four allogenic haematopoietic-transplated patients and discuss the possible aetiology and treatment. Patients/methods Four patients, two children and two adults affected by either mild or severe chronic GVHD, developed an erythematous rash on sun- or narrow-band ultraviolet B-exposed area, which triggered the onset of acute les...
A 28-year-old nursing student working in Juba, South Sudan, suddenly developed a rash over her mid-right clavicle. Beginning as a 10-cm-diameter erythematous patch with an irregular border, within 24 hours it had developed an increasingly gray, necrotic center, appearing similar to a burn. The patient was seen by 2 local physicians without a diagnosis being made. Ultimately, it was diagnosed as being caused by the toxic hemolymph, pederin, from the Nairobi fly (Paederus). The rash usually affects body parts not covered by clothing; healing time ranges from 7 to 28 days, usually with permanent skin discoloration. Preventive measures include typical antivector precautions, including bed nets, long-sleeve clothing, and avoiding fluorescent lights. If the beetles are found on the skin, brushin...
Summary Reiter disease (RD) is characterized by a triad of sterile arthritis, urethritis and conjunctivitis. The conditions occur concomitantly or sequentially, and are associated with mucocutaneous features such as circinate balanitis and stomatitis. Arthritis usually occurs in attacks followed by recovery, but it sometimes progresses to permanent damage of the affected joints. Because the symptoms of this disorder are attributable to activated neutrophils, we assessed the efficacy of granulocyte and monocyte adsorption apheresis (GCAP) in a 73-year-old man with RD who had skin rashes on his penis, scrotum and right hand, with severe arthralgia. The patient-s skin rash and joint pain responded dramatically to five sessions of GCAP delivered at intervals of 5-days. We present a detailed de...
Here we report an atypical case of meningococcemia presenting as peritonitis and later developing a centrifugal rash. The patient was a previously healthy 21-year-old Hispanic male who presented to the Emergency Department with a low-grade fever, right lower quadrant pain, and right lower extremity myalgia. Physical exam was suggestive for appendicitis, and the patient was showing signs of septic shock: hypotension, tachypnea, tachycardia, and a mottled appearance shortly after admission. Exploratory surgeries of the abdominal cavity and right lower extremity were unable to identify the nidus of infection. Eight hours after admission the patient was noted to have a petechial rash, which rapidly progressed to purpura fulminans (PF) within the first hour of its initial appearance. Paradoxica...
Background A retrospective, registry-based analysis to assess the outcomes of metastatic renal cell cancer (mRCC) patients treated with sunitinib and sorafenib who developed dermatologic adverse events was performed. Patients and Methods Data on mRCC patients treated with sunitinib or sorafenib were obtained from the Czech Clinical Registry of Renal Cell Cancer Patients. Outcomes of patients who developed hand-foot syndrome (HFS) of any grade and/or grade 3/4 rash during the treatment were compared with patients without HFS and no, mild, or moderate rash. Results The cohort included 705 patients treated with sunitinib and 365 patients treated with sorafenib. For sunitinib, the median overall survival (OS) was 43.0 months versus 31.0 months (P = 0.027) and median progression-free survival (...
Objective: The purpose of this report is to present a case of herpes zoster in a 6-month-old infant, conservatively managed without oral antivirals, and its 13-year follow-up, demonstrating no sequelae or recurrences. Clinical Features: A 6-month-old white female infant presented with a vesicular rash of the right lower extremity to a chiropractic office. The rash consisted of grouped vesicles on erythematous plaques, the characteristic herpetiform lesion, distributed in the S1 dermatome of the right lower extremity only. The infant's history was significant for exposure to chicken pox at age 1 week through siblings. Consequently, only one vesicle developed, representing subclinical chicken pox. The clinical diagnosis of herpes zoster was made. Intervention and Outcome: The infant was trea...
Current serological evidence suggests the presence of scrub typhus and spotted fever group (SFG) rickettsiosis in Sri Lanka. Our objective was to identify rickettsial agents/Q fever as aetiological causes for patients who were presumed having rickettsioses by the presence of an eschar or a rash. Sera from patients with unknown origin fever from Matara were tested by immunofluorescence for SFG rickettsial antigens, typhus group rickettsiae, Orientia tsutsugamushi, and Coxiella burnetii antigens. Thirteen (7.3%) of the patients presented with a rash, 11 (6.1%) had an inoculation eschar, and 16 patients recalled a tick or flea bite. We found that 25 (14%) patients had scrub typhus, 6 (3%) SFG rickettsioses, 3 (1.6%) acute Q fever, 3 (1.6%) murine typhus, and 3 (1.6%) were infected by Rickettsia felis. In addition to already described scrub and murine typhus, we found that R. felis and C. burnetii infections should be considered in Sri Lanka. PMID:22492158
DRESS syndrome (Drug Rash, Eosinophilia and Systemic Symptoms) represents one pattern of the cutaneous involvement in type IV hypersensitivity reaction to drugs. It is a severe, delayed, idiosyncratic reaction presented as skin rash with fever, lymphadenopathy, and visceral involvement. There are several reported cases of sulfasalazine induced DRESS syndrome, but myocardial involvement was rare. High index of suspicion is needed in every patient receiving these drugs for prompt diagnosis and early management. We report a case of a 56-year-old lady treated with sulfasalazine for ankylosing spondylitis for 3 weeks, which was discontinued after development of DRESS syndrome. Despite treating her with high dose of steroid and cyclosporine, her symptoms persisted and ultimately she developed to...
Abstract Varicella zoster virus (VZV) is a leading cause of acute viral encephalitis but little is known about its clinical, biological and imaging features. Furthermore, the most favourable treatment regimen has not been determined. We studied a prospective cohort of 20 HIV-negative patients presenting with acute VZV encephalitis caused by primary infection or reactivation. VZV was identified in 16 of 20 cases by PCR detection of the DNA in the cerebrospinal fluid. The four remaining cases occurred during or soon after a VZV rash. The median age of the 17 adults was 76 (19-86) years; the three other patients were children (0.5-5-years). Three patients were immunocompromised. Nine adult patients presented with a rash. Eighteen patients presented with fever and an acute encephalitic syndrom...
Abstract in portuguese A infecção pelo Strongyloides stercoralis em associação com imunosupressão pode manifestar-se com lesões em múltiplos órgãos e sistemas, caracterizando a forma disseminada da doença. Lesões cutâneas não são freqüentemente relatadas e, se presentes, manifestam-se como rash e petéquias. Púrpuras bem definidas são pouco descritas. No presente trabalho é descrito um caso de estrongiloidíase disseminada, com acometimento cutâneo em forma de púrpura, que s (more) e desenvolveu em um paciente timectomizado e usuário crônico de corticosteróide devido à miastenia gravis. Abstract in english The association of systemic corticosteroid therapy and dissemination of Strongyloides stercoralis has been increasingly documented in the literature. Skin involvement in disseminated strongyloidiasis has been reported and the most commonly described cutaneous manifestations are rash and petechial eruptions. We present a case of an immunosuppressed man that developed disseminated strongyloidiasis with extensive purpura.
Photosensitivity, an abnormal skin reaction to light, is a rare adverse event associated with herbal medicine use. Case reports in the literature most commonly implicate St. John's wort. In this report, we describe the case of a 32-year-old woman who suffered a phototoxic reaction after taking a dietary supplement containing ginseng, goldenseal, bee pollen, and other ingredients. On presentation, she had a pruritic, erythematous rash, localized to the sun-exposed surfaces of her neck and extremities. She had no significant past medical history and was not taking any other medications. The skin rash slowly resolved after discontinuation of the supplement and with treatment including subcutaneous and topical corticosteroids. Although the individual ingredients in this dietary supplement have not been associated with cases of photosensitivity, it is possible that the combination of ingredients may have interacted to cause this toxic reaction. Therefore, we recommend caution in the combining of multiple herbs and supplements into new formulations. PMID:14677798
Schönlein-Henoch purpura (SHP) is a systemic vasculitis, primarily involving the skin, gastrointestinal (GI) tract, joints, and kidneys. A wide variety of different conditions may be implicated in the pathogenesis of SHP. We report a 33-year-old man who presented with SHP accompanied by gastric Helicobacter pylori (Hp) infection. The GI manifestations and purpuric rashes were dramatically resolved after Hp eradication therapy. To date, very few publications have focused on the possible pathogenetic relationship between Hp infection and SHP.
: A wide spectrum of skin toxicities has been described in patients receiving epidermal growth factor receptor (EGFR), inhibitors, including papulopustular rash, xerosis and fissures, pruritus, mucositis, paronychia, and hair changes.Trichomegaly of the eyelashes is a rare adverse effect of EGFR inhibitor therapy and is characterized by a paradoxical overgrowth of eyelashes. We present 3 cases of trichomegaly occurred during EGFR inhibitor therapy. PMID:23010833
We report the case of an 86-year-old man with acute left shoulder pain, followed by left limb monoparesis and a herpetic rash on the left upper limb and thoracic region. This situation presented a diagnostic challenge because of the simultaneity of symptoms attributable to Parsonage-Turner syndrome and herpes zoster neuropathy. A detailed clinical history, physical examination and electroneuromyography were essential to distinguish the neurological structures involved and to ascertain the diagnosis. PMID:21829402
Rickettsia typhi causes endemic typhus, a relatively mild, acute febrile illness characterized by headache and macular rash. It is maintained in rodents and transmitted to humans by flea Xenopsylla cheopis. R. typhi contains a lipopolysaccharide thought to display a noticeable antigenic activity. We examined its structural features and it appears that the O-specific chain of the R. typhi LPS is composed mainly of the alternating Glc and QuiNAc residues linked by 1-->4 bonds. PMID:16481524
Abstract Several spotted fever group rickettsiae (SFGR) previously believed to be nonpathogenic are speculated to contribute to infections commonly misdiagnosed as Rocky Mountain spotted fever (RMSF) in the United States, but confirmation is difficult in cases with mild or absent systemic symptoms. We report an afebrile rash illness occurring in a patient 4 days after being bitten by a Rickettsia montanensis-positive Dermacentor variabilis tick. The patient's serological profile was consistent with confirmed SFGR infection. PMID:23153005
To relate the clinical findings of parvovirus B19 infection to the phase of the disease, we performed a retrospective chart review of 30 adult patients who tested positive for IgM antibody against parvovirus B19 at our hospital from March 2003 to November 2008. Median patient age was 38 years, with 86.7% aged between 26 and 45 years. The male-to-female ratio was 4:26 (86.7% female). Symptoms in the first phase were mainly flu-like, including fever, headache, or myalgia. Symptoms in the second phase were arthralgia in 24 (85.7%) and rash in 23 (82.1%). Fever was observed in 21 (70.0%), and 22 (75.9%) were found to be lymphopenic. The onsets in 73.3% of cases were concentrated within 10.1% of the study period, an observation nearly consistent with an outbreak of erythema infectiosum. Three patients had symmetrical swelling of joints, all of whom also had rash. Most patients visited the hospital within a week of onset and prognosis was favorable. In the parvovirus B19 infection, flu-like symptoms were frequent in the first phase, while rash and arthralgia were common in the second. Female sex, age between 26 and 45, and presence of rash, arthralgia, fever, and lymphopenia were clinical findings with a high frequency (?70%), and these factors may contribute to diagnosis. In an era when early diagnosis and therapy is required in rheumatoid arthritis, it is important to recognize the parvovirus B19 infection with a presentation of acute arthritis and a favorable prognosis. PMID:20680378
ABSTRACT: We report a case of scarlet fever associated with hepatitis, gallbladder hydrops, splenomegaly, and ascites in a 15-year-old girl. The girl presented with fever and skin rash. Leukocyte, liver enzyme, and serum C-reactive protein concentrations were elevated. Ultrasonography revealed marked gallbladder wall thickening, diffuse liver parenchymal disease with moderate splenomegaly, and moderate ascites throughout the abdominal and pelvic cavities. Blood cultures for group A ?-hemolytic streptococci were negative. Complete recovery was facilitated with antibiotic treatment. PMID:23128648
Abstract A 51-year-old man presented with a 12-year history of an expanding, irritable rash on his buttocks, groin and scrotum. He gradually developed erythematous, annular plaques with ridged borders and depressed centres. He also had a verruciform eruption in his perianal area. A clinical diagnosis of porokeratosis confined to the genitogluteal area was confirmed histopathologically. Oral acitretin resulted in symptomatic and cosmetic improvement. He continues to be followed up to evaluate treatment outcomes.
Hypereosinophilia may be associated with any of several underlying diseases. Atopy or allergic drug reactions are the most common causes, but infections with bacteria and parasites should also be considered in the differential diagnosis. When thorough evaluation of a patient with chronic hypereosinophilia fails to reveal an underlying disease, the diagnosis of idiopathic hypereosinophilic syndrome (HES) should be considered. We report a patient with unexplained persistent hypereosinophilia associated with a chronic pruritic rash and an underlying diagnosis of HES (lymphocytic variant). PMID:20236287
Abstract Dengue is characterized by biphasic fever, myalgia or arthralgia, rash, leukopenia, and lymphadenopathy. It is self-limiting, and dengue-associated haemophagocytic lymphohistiocytosis has been reported in fewer than 20 children worldwide. We report the case of a 4-y-old boy with dengue who continued to have fever for 30 days, with hepatomegaly, thrombocytopenia, and leukopenia. Bone marrow examination showed haemophagocytes. The child was treated with steroids, instead etoposide and oral cyclosporine.
To evaluate normal variations and thus to avoid confusion in differentiation from lesions of the accessory structures (rhomboid fossa, foramen for supraclavicular nerve, conoid tubercle) of the clavicle in chest radiographs. We studied the variations of the clavicle in 300 chest radiographs (134 men, 166 women) and 355 dry bones (right 166, left 189;151 men, 74 women, 130 unknown sex). In chest radiographs, the incidence of the depressed rhomboid fossa was 229 cases (39.5%; male 52.0%, female 29.9%); the flat type was 329 cases (56.9%; male 45.7%, female 65.7%); and the elevated type was 20 cases (3.5%;male 2.4%, female 4.3%). In the dry bones, the incidence of the depressed rhomboid fossa was 129 cases (57.3%; male 59.6%, female 52.7%); the flat type was 65 cases (28.9%; male 24.5%, female 37.8%); and the elevated type was 31 cases (13.8%; male 15.9%, female 9.5%). The incidence of the foramen for supraclavicular nerve was 0.8% in chest radiographs, and 1.4% in the dry bones. The incidence of the elevated conoid tubercle was 65.1% (male 64.0%, female 65.9%) in chest radiographs, and 96.9% (male 95.4%, female 100.0%) in the dry bones. The incidence of the depressed rhomboid fossa in chest radiographs was higher in men and the right clavicle. The incidence of flat rhomboid fossa in chest radiographs decreased according to increase of age. The foramen for supraclavicular nerve was occasionally found ( 0.8% in chest radiographs; 1.4% in the dry bones)
To determine the computed tomographic (CT) findings of atresia and stenosis of the external auditory canal (EAC), and to describe associated abnormalities in surrounding structures. We retrospectively reviewed the axial and coronal CT images of the temporal bone in 15 patients (M:F=8:7;mean age, 15.8 years) with 16 cases of EAC atresia (unilateral n=11, bilateral n=1) and EAC stenosis (unilateral n=3). Associated abnormalities of the EAC, tympanic cavity, ossicles, mastoid air cells, eustachian tube, facial nerve course, mandibular condyle and condylar fossa, sigmoid sinus and jugular bulb, and the base of the middle cranial fossa were evaluated. Thirteen cases of bony EAC atresia (one bilateral), with an atretic bony plate, were noted, and one case of unilateral membranous atresia, in which a soft tissue the EAC. A unilateral lesion occurred more frequently on the right temporal bone (n=8, 73%). Associated abnormalities included a small tympanic cavity (n=8, 62%), decreased mastoid pneumatization (n=8, 62%), displacement of the mandibular condyle and the posterior wall of the condylar fossa (n=7, 54%), dilatation of the Eustachian tube (n=7, 54%), and inferior displacement of the temporal fossa base (n=8, 62%). Abnormalities of ossicles were noted in the malleolus (n=12, 92%), incus (n=10, 77%) and stapes (n=6, 46%). The course of the facial nerve was abnormal in four cases, and abnormality of the auditory canal was noted in one. Among three cases of EAC stenosis, ossicular aplasia was observed in one, and in another the location of the mandibular condyle and condylar fossa was abnormal. In the remaining case there was no associated abnormality. Atresia of the EAC is frequently accompanied by abnormalities of the middle ear cavity, ossicles, and adjacent structures other than the inner ear. For patients with atresia and stenosis of this canal, CT of the temporal bone is essentially helpful in evaluating these associated abnormalities.
Objective. During routine MR imaging of temporomandibular joints we have observed that an area of low signal is sometimes identified within the temporal bone overlying the glenoid fossa on proton-density sequences. This finding at times simulates a mass. CT in this situation has demonstrated marked pneumatization of the mastoid air cell extending to that portion of the temporal bone overlying the glenoid fossa. We undertook a clinical study to determine the frequency and appearance of such a finding.Design and patients. We reviewed the images of 12 patients who underwent both MR and CT examinations of their temporomandibular joints. The authors, by consensus, graded all 24 joints using a four-point scale for the presence and appearance of a low-signal area overlying the glenoid fossa on the MR images prior to seeing the corresponding CT images. We then compared our grading with the findings on CT to assess for the presence and extent of pneumatization of the temporal bone overlying the glenoid fossa.Results. Of the 24 joints reviewed there was identical extent of low signal on MR imaging and extent of pneumatization on CT in 22 of 24 joints. In two of the 24 joints assessed there was overestimation of pneumatization due to extensive sclerosis secondary to surgery.Conclusion. The findings of an area of low signal overlying the glenoid fossa on a T2-weighted scan of a nonoperative temporomandibular joint is often due to extensive temporal bone pneumatization of the mastoid air cells. Recognition of the nature of this finding will avoid mistaking it for a fibrous or osseous lesion. Patients with previous operative history may, however, require further investigation with CT. (orig.)
144 patients operated on for trigeminal neuralgia between June 1982 and May 1990 were followed for up to 8 years. 122 patients were treated by retrogasserian glycerol rhizolysis and 22 by posterior fossa exploration. The average age was 65 years. 89 patients were women and 55 men. The 1st branch was principally involved in 9 patients, the 2nd in 92 and the 3rd in 43. 32 patients had prior procedures. 102 of the 122 patients submitted to glycerol injection were rendered pain-free (84%). An additional 7 patients were relieved by a supplemental radiofrequency procedure, thus achieving an 89% success rate with the percutaneous approach. All 22 posterior fossa explorations were initially successful. 65 patients of the group treated percutaneously had some new postoperative objective and/or subjective sensory deficit as well as 13 of the patients operated on by posterior fossa exploration. Corneal sensation was decreased after 19 glycerol procedures including 3 who had a supplemental radiofrequency coagulation. No corneal hypaesthesia was seen after posterior fossa explorations. Kaplan-Meier analysis showed that at 5 years 59% of the percutaneous rhizolysis group were free of neuralgia and 68% of the patients treated by posterior fossa exploration. A number of patient characteristics and surgical factors were analysed for a possible correlation with outcome. Intact preoperative facial sensation was the most important prognostic factor for an initially successful operative result. Some degree of postoperative sensory deficit was the most important factor for long-term remission of neuralgia. However, of the 54 patients with a postoperative new sensory deficit who were available for long-term follow-up, 13 complained of persistent disturbing disaesthesias. PMID:1799138
Results of radiation therapy for cerebellar medulloblastoma at Kyoto University Hospital were reviewed. Between 1962 and 1988, 30 patients with histologically-proven medulloblastoma completed radiotherapy. Before 1971, the treatment volume was either the posterior fossa only or posterior fossa plus spinal axis, but after 1972, it was extended to include the entire neuraxis. The mean dose was 48 Gy to the posterior fossa, 36 Gy to the whole brain, and 25 Gy to the spinal axis. The 5-year survival rate and 5-year relapse-free survival rate estimated by the Kaplan-Meier's method were 36% and 37%, respectively, for total cases, but were as high as 79% and 80%, respectively, for the recent 10 patients. This improvement in the treatment results appeared to be due to extensive tumor resection and improved radiotherapy technique, and not to the use of chemotherapy. The prognosis was significantly better in patients treated with craniospinal irradiation than in those otherwise treated. There was a trend towards better survival in patients who received 50 Gy or more to the posterior fossa or 24 Gy or more to the spinal axis, compared to the patients who received lower doses to each site. No significant morbidity of radiotherapy was seen. Four of the six surviving patients who were treated below age 12 have a mental retardation and/or a short stature, but one patient treated at age 5 has a normal growth and a good intelligence. From these analysis, it is recommended to irradiate craniospinal axis and posterior fossa up to 25{approx}35 Gy and 50{approx}55 Gy, respectively. (author).
This study was performed to evaluate the effectiveness and tolerance of craniospinal irradiation for patients with medulloblastoma and to define the optimal radiotherapeutic regimen. We retrospectively analyzed the records of 43 patients with medulloblastoma who were treated with external beam craniospinal radiotherapy at our institution between May, 1984 and April, 1998. Median follow up period was 47 months with range of 18 to 86 months. Twenty seven patients were male and sixteen patients were female, a male to female ratio of 1.7:1. Surgery consisted of biopsy alone in 5 patients, subtotal excision in 24 patients, and gross total excision in 14 patients. All of the patients were treated with craniospinal irradiation. All of the patients except four received fat least 5,000 cGy to the posterior fossa and forty patients received more than 3,000 cGy to the spinal cord. The overall survival rates at 5 and 7 years for entire group of patients were 67% and 56%, respectively. Corresponding disease free survival rates were 60% and 51%, respectively. The rates of disease control in the posterior fossa were 77% and 67% at 5 and 7 years. Gross total excision and subtotal excision resulted in 5 year overall survival rates of 76% and 66%, respectively. in contrast, those patients who had biopsy alone had a 5 year survival rate of only 40%. Posterior fossa was a component of failure in 11 of the 18 recurrences. Seven recurrences were isolated to the posterior fossa. Four patients had neuraxis recurrences, three had distant metastasis alone and four had multiple sites of failure, all involving the primary site. Craniospinal irradiation for patients with medulloblastoma is an effective adjuvant treatment without significant treatment related toxicities. There is room for improvement in terms of posterior fossa control, especially in biopsy alone patients. The advances in radiotherapy including hyperfractionation, stereotactic radiosurgery and 3D conformal radiotherapy would be evolved to improve the tumor control rate at primary site.
Abstract in spanish Objetivo: Establecer la asociación del Apgar con las variables hematológicas en pacientes con anemia materna crónica severa y trabajo de parto normal. Método: Es un estudio descriptivo y prospectivo. Se seleccionaron 90 pacientes con diagnóstico de anemia crónica severa y trabajo de parto para ser incluidas en el estudio. Se tomó sangre periférica de la vena antecubital para cuantificar las concentraciones de hemoglobina, vitamina B12, ácido fólico, hierro séri (more) co y ferritina. Una vez atendido el parto al recién nacido se le determinó el Apgar al minuto y a los 5 minutos. Ambiente: Maternidad "Dr. Nerio Belloso". Hospital Central "Dr. Urquinaona". Maracaibo, Estado Zulia. Resultados: El valor promedio del Apgar al minuto fue de 6,9 ± 0,8 puntos y a los 5 minutos de 8,7 ± 0,4 puntos. El valor promedio de vitamina B12 fue de 324,2 ± 80,5 pg/mL y de ácido fólico fue de 7,7 ± 8,2 ng/mL. Las concentraciones de hierro sérico fueron de 46,3 ± 42,4 mg/dL y la de ferritina fue de 37,1 ± 35,5 pg/mL. Sólo se encontró una correlación débilmente negativa y estadísticamente significativa entre el Apgar a los 5 minutos y las concentraciones séricas de vitamina B12 (r = - 0,256, P Abstract in english Objective: To establish an association of Apgar with hematological variables in patients with severe chronic maternal anemia and labor. Method: Ninety patients were selected with a diagnosis of severe chronic anemia and labor to be included in the research. Peripherical blood was recollected from antecubital vein to quantify concentrations of hemoglobin, vitamin B12, folic acid, serum iron and ferritin. Once the newborn was assisted Apgar at minute and at five minutes was (more) determined. Setting: Maternidad "Dr. Nerio Belloso". Hospital Central "Dr. Urquinaona". Maracaibo, Estado Zulia. Results: Mean value of Apgar at minute was 6.9 ± 0.8 and at five minutes of 8.7 ± 0.4 points. Mean value of vitamin B12 was 342.2 ± 80.5 ng/mL and folic acid was 7.7 ± 8.2 ng/mL. Serum iron concentration was 46.3 ± 42.4 mg/dL and ferritin concentration was 37.1 ± 35.5 pg/mL. There was only a weak negative correlation and statically significant between five minute Apgar and serum concentration of vitamin B12 (r = - 0.256; P
The Georgia Gulf Corporation, Tiptonville, Tennessee, was investigated because of an outbreak of dermatitis. The facility produced polyvinyl-chloride compound by blending polyvinyl-chloride resin with other ingredients. Rashes were reported by 22 production workers and three clerical or management workers. Examination of seven of the workers indicated that all of them appeared to have contact dermatitis. Rashes were found in areas of the body where powders may come in contact with the body, and the rashes improved when away from work. Blender operators had a significantly elevated risk of developing dermatitis compared with production workers who had lower exposures to dusts and powders. The report concludes that the dermatitis was probably of occupational origin, due to exposure to airborne pigment powders and acrylic polymers containing residual monomers. The report recommends measures to reduce exposures and prevent dermatitis, including showering at the end of a work shift that involved exposure to dusts and powders, reduction of airborne dust levels through engineering controls, and the use of protective clothing, barrier creams, and skin moisturizers.
Abstract in english Human parvovirus B19 infection can cause erythema infectiosum (EI) and several other clinical presentations. Central nervous system (CNS) involvement is rare, and only a few reports of encephalitis and aseptic meningitis have been published. Here, we describe 2 cases of B19 infection in a family presenting different clinical features. A 30 year old female with a 7-day history of headache, malaise, myalgias, joint pains, and rash was seen. Physical examination revealed a m (more) aculopapular rash on the patient's body, and arthritis of the hands. She completely recovered in 1 week. Two days before, her 6 year old son had been admitted to a clinic with a 1-day history of fever, headache, abdominal pain and vomiting. On admission, he was alert, and physical examination revealed neck stiffness, Kerning and Brudzinski signs, and a petechial rash on his trunk and extremities. Cerebrospinal fluid analysis was normal. He completely recovered in 5 days. Acute and convalescent sera of both patients were positive for specific IgM antibody to B19. Human parvovirus B19 should be considered in the differential diagnosis of aseptic meningitis, particularly during outbreaks of erythema infectiosum. The disease may mimic meningococcemia and bacterial meningitis.
Background and Objectives The clinical features of parvovirus B19 infection in adult patients have not been well described. The aim of this prospective study was to clarify the clinical features of adult patients with parvovirus B19 infection in primary care settings. Methods The study subjects were adults over age 18 years who had visited one primary care clinic over a period of one year. They were chosen if they had at least two of the following three symptoms: edema, joint pain, and rash, and if they had contact with children with erythema infectiosum. The diagnosis was confirmed if anti-parvovirus B19 antibodies were identified. The process of these symptoms was recorded until they resolved. Results Twenty patients met the inclusion criteria, and 14 (70%) patients were diagnosed with parvovirus B19 infection. The 14 adult patients consisted of two men and twelve women ranging from 33 to 63 years (median, 38 years). The patients consisted of two groups. In the first group, they presented with the first phase of infection showing symptoms such as malaise, muscle pain, and fever, and in the second phase presented with edema, rash, and joint pain that developed within two days of the first phase. In the second group, the first and second phases were clearly separated. Conclusions Parvovirus B19 infection in adults can be efficiently diagnosed in primary care settings by observing clinical symptoms such as edema, joint pain, and rash, and by asking patients about their contact with children who have erythema infectiosum.
Abstract in spanish El síndrome de hipersensibilidad a drogas o síndrome DRESS es una reacción rara y potencialmente fatal; se caracteriza por presentar la tríada de fiebre, rash y compromiso de órganos internos. Fenitoína, fenobarbital y carbamazepina son los anticonvulsivantes aromáticos que con más frecuencia causan esta reacción. Dicho síndrome ocurre entre la 1ra y 8va semanas después de la exposición al fármaco. La eliminación inmediata de la droga es esencial para el man (more) ejo de estos pacientes. Presentamos una paciente de sexo femenino, de 62 años, medicada con carbamazepina durante un mes, que consulta por fiebre, mal estado general y rash máculopapuloso que se generalizó hasta abarcar el 90% de la superficie cutánea. Abstract in english Anticonvulsivant hypersensitivity syndrome (AHS) is a rare and potentially fatal reaction characterized by the appearance of fever, skin rash and internal organ involvement. Phenytoin, phenobarbital and carbamazepine are the most frequent aromatic anticonvulsivant causing the reaction. This syndrome occurs 1-8 weeks after the initial drug exposure.
A 77-year-old woman suffering from chronic bronchial asthma and chronic atrial fibrillation who had had a previous ischemic stroke presented to our emergency unit with gait disturbance. She had new-onset truncal ataxia, right hemiparesis, and right sensory disturbance related to the previous stroke. Her lower legs were slightly swollen and had a reddened appearance. Her medical history included mitral valve replacement because of severe mitral valve regurgitation. Her white blood cell count was 8600/?L, mainly consisting of eosinophils (4480/?L; 52.1%). Serum nonspecific immunoglobulin E was elevated to 1600 IU/mL (normal range stenosis or occlusion was shown in the cervicocephalic arteries on magnetic resonance angiography or carotid ultrasound. No emboligenic diseases, except for atrial fibrillation, were identified. On day 3, an extensive itchy, purpuric rash appeared on her lower limbs. The rash remitted and recurred spontaneously for several weeks. A skin biopsy specimen of the purpuric lesions revealed massive eosinophilic infiltration of the dermis and eosinophilic vasculitis involving small vessels. We diagnosed the patient with Churg-Strauss syndrome (CSS). Skin lesions and eosinophilia disappeared after oral corticosteroid therapy. In this case, cerebellar infarction occurred with purpuric rash despite well-controlled anticoagulation. Patients with CSS may suffer from ischemic stroke when the condition of CSS deteriorates. PMID:22209309
In our previous study, uterine endometrial atypical hyperplasias and adenocarcinomas were induced in female transgenic mice harboring human proto type c-Ha-ras gene (rasH2 mice) within 22 weeks by a single intraperitoneal injection of N-ethyl-N-nitrosourea (ENU). In order to clarify the modifying effects of genistein (GE), 4-nonylphenol (NP), and methoxychlor (MXC) on uterine endometrial carcinogenesis, female rasH2 mice received an intraperitoneal injection of 120 mg/kg body weight (bw) of ENU, followed by no further treatment, diet containing 250 ppm GE, diet containing 250 ppm NP, or diet containing 1,000 ppm MXC for 24 weeks. Uterine proliferative lesions that were observed in treated groups were composed of endometrial hyperplasias, atypical hyperplasias of the endometrium, and adenocarcinomas. The incidence of adenocarcinomas in the ENU alone, ENU+GE, ENU+NP, and ENU+MXC groups was 55.6, 57.1, 47.1, and 0%, respectively, that in the ENU+MXC group being significantly depressed as compared to the ENU alone group (p<0.05). The incidence of atypical hyperplasias in the ENU+MXC group was also decreased. The results in the present study suggest that 1,000 ppm MXC, but not GE and NP, shows an inhibitory effect on the development of uterine adenocarcinomas in rasH2 mice initiated with ENU.
In this study, we have described the clinical characteristics of vaccine-modified measles to assess the performance of an expanded case definition in a school outbreak that occurred in 2010. The sensitivity, specificity, and the positive and negative predictive values were evaluated. Among 74 cases of vaccine-modified measles, 47 (64%) met the original case definition. Fever and rash were observed in 73% (54/74); fever was the most common (96%, 71/74) presenting symptom, and rash was noted in 77% (57/74) of the cases. The original case definition showed an overall sensitivity of 63.5% and a specificity of 100.0%. The expanded case definition combining fever and rash showed a higher sensitivity (72.9%) but a lower specificity (88.2%) than the original. The presence of fever and one or more of cough, coryza, or conjunctivitis scored the highest sensitivity among the combinations of signs and symptoms (77.0%), but scored the lowest specificity (52.9%). The expanded case definition was sensitive in identifying suspected cases of vaccine-modified measles. We suggest using this expanded definition for outbreak investigation in a closed community, and consider further discussions on expanding the case definition of measles for routine surveillance in South Korea.
The 2003 monkeypox virus (MPXV) outbreak and subsequent laboratory studies demonstrated that the black-tailed prairie dog is susceptible to MPXV infection and that the ensuing rash illness is similar to human systemic orthopoxvirus (OPXV) infection, including a 7- to 9-day incubation period and, likely, in some cases a respiratory route of infection; these features distinguish this model from others. The need for safe and efficacious vaccines for OPVX in areas where it is endemic or epidemic is important to protect an increasingly OPXV-naïve population. In this study, we tested current and investigational smallpox vaccines for safety, induction of anti-OPXV antibodies, and protection against mortality and morbidity in two MPXV challenges. None of the smallpox vaccines caused illness in this model, and all vaccinated animals showed anti-OPXV antibody responses and neutralizing antibody. We tested vaccine efficacy by challenging the animals with 10(5) or 10(6) PFU Congo Basin MPXV 30 days postvaccination and evaluating morbidity and mortality. Our results demonstrated that vaccination with either Dryvax or Acambis2000 protected the animals from death with no rash illness. Vaccination with IMVAMUNE also protected the animals from death, albeit with (modified) rash illness. Based on the results of this study, we believe prairie dogs offer a novel and potentially useful small animal model for the safety and efficacy testing of smallpox vaccines in pre- and postexposure vaccine testing, which is important for public health planning. PMID:21632764
Introduction. Lyme disease is an emerging worldwide infectious disease with major foci of endemicity in North America and regions of temperate Eurasia. The erythema migrans rash associated with early infection is found in approximately 80% of patients and can have a range of appearances including the classic target bull's-eye lesion and nontarget appearing lesions. Methods. A survey was designed to assess the ability of the general public to distinguish various appearances of erythema migrans from non-Lyme rashes. Participants were solicited from individuals who visited an educational website about Lyme disease. Results. Of 3,104 people who accessed a rash identification survey, 72.7% of participants correctly identified the classic target erythema migrans commonly associated with Lyme disease. A mean of 20.5% of participants was able to correctly identify the four nonclassic erythema migrans. 24.2% of participants incorrectly identified a tick bite reaction in the skin as erythema migrans. Conclusions. Participants were most familiar with the classic target erythema migrans of Lyme disease but were unlikely to correctly identify the nonclassic erythema migrans. These results identify an opportunity for educational intervention to improve early recognition of Lyme disease and to increase the patient's appropriate use of medical services for early Lyme disease diagnosis. PMID:15085185
Mapping studies using traditional photogeologic and modern digital geologic mapping techniques of Mawrth Vallis (six MTM quads; 17.5-27.5N, 335-350E) and Nili Fossae (six MTM quads; 17.5-32.5N, 070-080E) at 1:1M-scale are being used to assess geologic materials and processes that shape the highlands along the Arabia Terra dichotomy boundary. Placing these landscapes, their material units, structural features, and unique compositional outcrops into broad spatial and temporal context may help to constrain: a) paleo-environments and climate conditions through time, b) fluvial-nival modification processes related to past and present volatile distribution and their putative reservoirs (aquifers, lakes and oceans, surface and ground ice) and c) the influences of nearby volcanic and tectonic features on hydrologic systems and processes, including possible hydrothermal alteration, across the region. Since the initial discovery of phyllosilicate-bearing materials by the OMEGA instrument (Poulet et al., 2005; Bibring et al., 2006], Mawrth Vallis and Nili Fossae have become areas of intense scrutiny by high-resolution cameras and spectrometers. The mineralogic diversity (a variety of clays, unaltered ferromagnesian silicates, sulfates, and small detections of carbonate) is unprecedented on the surface of Mars and requires stratigraphic sequencing to unlock their complex histories. Mapping to date has delineated 12 geologic units for Mawrth Vallis and 17 for Nili Fossae. Mawrth Vallis units include: Acidalia Planitia; Arabia Terra, members 1&2; Mawrth Vallis channel; Mawrth Vallis plains, members 1-4; and several crater facies. Nili Fossae units are: Arabia Terra plateau sequence, members 1-5, Arabia Plateau etched, members a-c; Borealis plains; Isisdis plains, members 1-3, Syrtis Major flows, members 1,2a,&2b, crater facies, and surficial deposits. It is our hope that the small-scale mapping being performed herein may provide regional context for larger-scale and more focused studies (e.g., MSL landing site surveys) investigating the distribution, stratigraphic position, and potential lateral continuity of compositionally distinct outcrops as identified by instruments in orbit. Geologic Map of Nili Fossae. Updated maps of Nili Fossae and Mawrth Vallis will be presented and available for digital distribution.
Abstract in english BACKGROUND: Plasma D-dimer levels are directly related to the intra- and extra-vascular coagulation that occurs in acute and chronic lung damage in patients with community-acquired pneumonia (CAP). OBJECTIVES: This study examines the relationship between the severity of community-acquired pneumonia and D-dimer levels. In addition, the study examines the correlations among community-acquired pneumonia, the radiological extent of the disease and mortality. METHODS: The Pneu (more) monia Severity Index was used to classify patients into five groups. Patients were treated at home or in the hospital according to the guidelines for community-acquired pneumonia. Blood samples were taken from the antecubital vein with an injector and placed into citrated tubes. After they were centrifuged, the samples were evaluated with the quantitative latex method. RESULTS: The study included 60 patients who had been diagnosed with community-acquired pneumonia (mean age 62.5 ± 11.7) and 24 healthy controls (mean age 59.63 ± 6.63). The average plasma D-dimer levels were 337.3 ± 195.1ng/mL in the outpatient treatment group, 691.0 ± 180.5 in the inpatient treatment group, 1363.2 ± 331.5 ng/mLin the intensive care treatment group and 161.3 ± 38.1ng/mL in the control group (p
We studied patients with epilepsy by neuro-pharmacological functional MRI technique using diazepam. Five normal volunteers and 7 patients with epilepsy were investigated. MRI was performed by a 1.5 T unit (SIGNA Horizon, GE) using the following parameters: TR/TE 5000 msec/80 msec, FA 90 deg, FOV 200 mm, matrix 128 x 128, slice thickness 7 mm. We performed MRI scanning over 5 minutes (2 minutes before and 3 minutes after injection of diazepam) for each 1 session; we scanned 3 sessions for each patient at intervals of 5 minutes. The diazepam was injected rapidly from the antecubital vein. The dose of diazepam was 0.05 mg/kg/injection (total dose was 0.15 mg/kg). The data were analyzed statistically using t-test. Signal change after administration of diazepam was less than 1 to 2% in healthy volunteers. By contrast, in patient with epilepsy, the signal change was almost 3%, which was significantly greater than that of the normal area (p=0.01). The neuro-pharmacological functional MRI technique using diazepam might be a useful method to identify epileptic foci. (author)
To compare the clinical utility of contrast-enhanced color Doppler US in the differentiation of retinal detachment (RD) from vitreous membrane (VM) with that of various conventional US modalities, and to analyze the enhancement patterns in cases showing an enhancement effect. In 32 eyes examined over a recent two-year period, RD (n=14) and VM (n=18) were confirmed by surgery (n=28) or clinical follow-up (n=4). In all cases, gray-scale, color Doppler, and power Doppler US were performed prior to contrast injection, and after the intravenous injection of Levovist (Schering, Berlin) by hand for 30 seconds at a dose of 2.5 g and a concentration of 300 mg/mL via an antecubital vein, contrast-enhanced color Doppler US was performed. At Doppler US, the diagnostic criterion for RD and VM was whether or not color signals were visualized in membranous structures. Diagnostic accuracy was 78% at gray-scale US, 81% at color Doppler US, 59% at power Doppler US, and 97% at contrast-enhanced color Doppler US. The sensitivity of color Doppler US to color signals in RD increased from 57% to 93% after contrast enhancement. The enhancement patterns observed were signal accentuation (n=3), signal extension (n=2), signal addition (n=3), and new signal visualization (n=5). Contrast-enhanced color Doppler US was the most accurate US modality for differentiating RD from VM, showing a significantly increased signal detection rate in RD.
The transradial approach for left heart catheterization has become increasingly popular recently because of its clinical benefits. We examined the safety and feasibility of a transforearm approach for bilateral cardiac catheterizations, using the radial artery and a superficial forearm vein (the cephalic, basilic, or median antecubital vein). Between August 2002 and October 2003, 296 right heart catheterizations were performed in our hospital. A superficial forearm vein was used in one group of 101 patients, of which 98 had a concomitant left heart catheterization through the radial artery. The femoral vein was used for right heart catheterization in the second group of 195 patients. Of these patients, 37 underwent left heart catheterization through the radial artery and 157 through the femoral artery. All instances of bilateral catheterizations were successful except for one complication of pseudoaneurysm occurring in the transfemoral group. The procedure time for right heart catheterization was significantly less in the forearm group than the femoral group. The transforearm group had a larger proportion of males and of patients undergoing diagnostic right heart catheterization for congestive heart failure, dilated cardiomyopathy, and ischemic cardiomyopathy. Patients with aortic stenosis (AS), atrial septal defect (ASD), and mitral stenosis (MS) were mainly restricted to the transfemoral approach. We conclude that the transradial artery and superficial forearm venous approach for bilateral cardiac catheterizations is a safe and feasible alternative to the femoral approach in a wide range of patients, with the exception of patients with AS, ASD, or MS.
BACKGROUND: Important characteristics for ideal skin preparations include long-lasting antimicrobial efficacy and low potential for skin irritation. METHODS: A total of 55 healthy adult subjects were enrolled to evaluate the antimicrobial effects of 3 test formulations applied to inguinal, abdominal, and antecubital sites at posttreatment time points of 30 seconds, 72 hours, and 7 days. To investigate skin irritation potential, the 3 formulations were tested in a 21-day repeat-insult patch test conducted on the skin of the backs of 23 healthy subjects. RESULTS: The mean log(10) reduction (MLR) at 7 days posttreatment produced by a 79% vol/vol ethanol containing 1% wt/vol chlorhexidine gluconate (1% CHG-EtOH) applied to abdominal sites was significantly superior to that produced by a 10% povidone-iodine solution (2.45 MLR vs 0.90 MLR; P isopropanol containing 2% wt/vol CHG (2% CHG-IPA) provided statistically equivalent persistence at 72 hours and 7 days posttreatment. The 1% CHG-EtOH had less skin irritation poetntial than the 2% CHG-IPA and the 10% povidone-iodine solution, although the differences were not statistically significant (P > .05). CONCLUSION: Considering its persistent effect and low skin irritation potential, the 1% CHG-EtOH preparation is expected to perform well in surgical site preparation to reduce the risk of surgery- and catheter-related bloodstream infection. PMID:23017546
Diclofenac sodium is a non-steroidal anti-inflammatory drug (NSAID). It undergoes extensive Phase I and Phase II metabolism and in vitro it is a specific CYP2C9 substrate. The first part of the study consisted of oral administration of 100 mg of diclofenac sodium (Voveran100) to 12 healthy male volunteers. Blood samples were collected from the antecubital vein at intervals of 0, 0.5, 1, 2, 3, 4, 5, 6, 7, and 8 hours. The second part of the study was conducted after a washout period of 7 days. Treatment with 500 mg p.o. of diosmin (Venex 500) was given daily for 9 days. On day 10, 100 mg of diclofenac sodium (Voveran 100) was administered. Blood samples were obtained as mentioned earlier and pharmacokinetic parameters of diclofenac before and after pretreatment with diosmin analyzed by HPLC. Diosmin pretreatment significantly enhanced AUC, C(max) and t1/2 with a concomitant reduction in CL/f. Diosmin might have inhibited the microsomal CYP2C9 mediated oxidation of diclofenac sodium. PMID:17708066
Chlorzoxazone, a centrally acting muscle relaxant, is a probe for cytochrome P450 2E1 (CYP2E1). The first part of the study consisted of oral administration of 250 mg of chlorzoxazone (Paraflex 250 tablet) alone to 12 healthy male volunteers. Blood samples were collected from the antecubital vein at intervals of 0, 0.5, 1, 2, 3, 4, 5, 6, 7, and 8 hours and urine voided during 0-4 and 4-8 hours was collected after the administration of chlorzoxazone. The second part of the study was conducted after a wash-out period of 7 days; 500 mg of diosmin (Venex 500) was administered daily for 9 days. On day 10, 250 mg of chlorzoxazone was administered. Blood and urine samples were obtained as mentioned above. Serum levels of chlorzoxazone were determined by HPLC. Pharmacokinetic parameters were determined based on non-compartmental model analysis using the computer program RAMKIN. Diosmin pretreatment significantly enhanced AUC, C(max) and t1/2 with a concomitant reduction in CL/f. The urinary excretion of 6-hydroxychlorzoxazone was decreased and unchanged chlorzoxazone was increased over 8 hours. Urinary metabolic ratios of 6-hydroxychlorazoxazone and chlorazoxazone were increased. After pretreatment with diosmin, overall excretion (0-8 h) of 6-hydroxychlorazoxazone and chlorazoxazone were decreased. Diosmin might have inhibited the microsomal CYP2E1-mediated hydroxylation of chlorazoxazone. PMID:19326774
Purpose:? To quantitate the effect of intravenous hypertonic saline (IVHTS) injection on elevated intraocular pressure (IOP). Methods:? Nineteen patients (median age, 65?years; range, 41-84?years) with glaucoma and an IOP 30?mmHg or higher were recruited. A bolus of IVHTS (sodium chloride concentration 23.4%) was injected in an antecubital vein over 10-20?seconds. The IOP and systolic and diastolic blood pressure (BP) were measured frequently for 2?hr. The dosage was 0.5?mmol/kg sodium in 11 patients (Group 1) and 1.0?mmol/kg in eight patients (Group 2). Results:? In both groups, a median absolute IOP reduction of 7?mmHg was achieved in 5?min. The maximum median reduction was 7?mmHg (range, 4-16) and 9?mmHg (range, 3-14) at 5 and 16?min after IVHTS in Group 1 and 2, respectively, at which point the median IOP had reduced from 38 and 35?mmHg to 31 and 27?mmHg (p?hypertonic saline solution reduces IOP moderately within minutes for up to 2?hr. PMID:22834976
The aim of the study was to investigate the influence of an increased intake of anthocyanins, contained in chokeberry juice, on the redox parameters in rowers performing a physical exercise during a 1-month training camp. The athletes were randomly assigned to receive 150 mL of chokeberry juice daily, containing 23 mg/100 mL of anthocyanins (supplemented group), or placebo (control group). Before and after the supplementation period, the subjects performed an incremental rowing exercise test. Blood samples were taken from the antecubital vein before each exercise test, 1 min after the test, and following a 24-h recovery period. After the supplementation period, TBARS concentrations in the samples collected 1 min after the exercise test and following a 24-h recovery period were significantly lower in the subjects receiving chokeberry juice than in the control group. In the supplemented group, glutathione peroxidase activity was lower in the samples collected 1 min after the exercise test, and superoxide dismutase activity was lower in the samples taken following a 24-h recovery, as compared to the subjects receiving placebo. These findings indicate that an increased intake of anthocyanins limits the exercise-induced oxidative damage to red blood cells, most probably by enhancing the endogenous antioxidant defense system. PMID:15902989
Prolonged head-down bed rest (HDBR) provides a model for examining responses to chronic weightlessness in humans. Eight healthy volunteers underwent HDBR for 2 wk. Antecubital venous blood was sampled for plasma levels of catechols [norepinephrine (NE), epinephrine, dopamine, dihydroxyphenylalanine, dihydroxyphenylglycol, and dihydroxyphenylacetic acid] after supine rest on a control (C) day and after 4 h and 7 and 14 days of HDBR. Urine was collected after 2 h of supine rest during day C, 2 h before HDBR, and during the intervals 1-4, 4-24, 144-168 (day 7), and 312-336 h (day 14) of HDBR. All subjects had decreased plasma and blood volumes (mean 16%), atriopeptin levels (31%), and peripheral venous pressure (26%) after HDBR. NE excretion on day 14 of HDBR was decreased by 35% from that on day C, without further trends as HDBR continued, whereas plasma levels were only variably and nonsignificantly decreased. Excretion rates of dihydroxyphenylglycol and dihydroxyphenylalanine decreased slightly during HDBR; excretion rates of epinephrine, dopamine, and dihydroxyphenylacetic acid and plasma levels of catechols were unchanged. The results suggest that HDBR produces sustained inhibition of sympathoneural release, turnover, and synthesis of NE without affecting adrenomedullary secretion or renal dopamine production. Concurrent hypovolemia probably interferes with detection of sympathoinhibition by plasma levels of NE and other catechols in this setting. Sympathoinhibition, despite decreased blood volume, may help to explain orthostatic intolerance in astronauts returning from spaceflights.
Retinal vein occlusion is an important cause of visual loss. Several ocular and systemic conditions have been reported for retinal vein occlusion. The pathogenesis of thrombus formation in the retinal vein, which results in retinal vein occlusion, is unclear. The aim of this study was to investigate the correlation between increased serum leptin levels and the occurrence of retinal vein occlusion (RVO). The study group consisted of 40 patients with RVO (58.1 ± 6 years old; 17 males and 23 females): 15 patients with central RVO, 23 with branch RVO, and 2 with hemispheric RVO. The patients who had any ocular or systemic pathology were not included in the study. The control group consisted of 40 healthy individuals of similar gender, age, date and type of health survey, and geographic region. The blood samples of the RVO patients (n = 40) and controls (n = 40) were obtained antecubitally. Leptin levels were measured by an enzyme-linked immunosorbent assay (ELISA) method, and Student's t-test was used to determine differences between the groups. The mean serum leptin levels were 12.5 ± 1.64 ng/ml in patients with RVO and 8.4 ± 1.22 ng/ml in the control subjects; namely, the mean serum leptin levels were significantly higher in the patients with RVO (p < 0.001). These results suggest that leptin may be involved in the pathogenesis of venous thrombosis in the retina probably through its effects on homeostasis of the vessel wall.
Airway inflammation and related respiratory complaints are common symptoms among waste management workers (WMWs). This study investigated the relationship between exposure to municipal solid waste (MSW) and the levels of inflammatory markers and oxidative stress among WMW of Ogun State, South West Nigeria. A total of 280 subjects consisting of 180 WMW and 100 controls were recruited. Ten millilitres of blood were collected from antecubital vein of the subjects for analysis. Results reveal that exposure to MSW is associated with systemic inflammation and oxidative stress. Significant (p 0.05) when compared with the control. A positive correlation between leucocytes (r = 0.195, p < 0.01), Cp (r = 0.210, p < 0.01) and job duration and between Cp and MDA (r = 0.200, p < 0.01) and Cp and leucocytes (r = 0.260, p < 0.001) were observed in WMW. Overall, exposure to MSW predisposes to systemic inflammation and oxidative stress and Cp may be a useful biomarker for monitoring health status of Nigerian WMWs. PMID:22577128
Abstract Aim: The aim of this study was to evaluate the transplacental transfer of clarithromycin, which was used in the treatment of preterm premature rupture of membranes (PPROM) in human pregnancies, by comparing umbilical cord and maternal serum clarithromycin concentrations. Methods: Singleton pregnant women with PPROM (Amniocentesis was offered, and culture for aerobe/anaerobe and mycoplasma was performed. After delivery, blood was drawn from the mother's antecubital and umbilical cord veins. Clarithromycin concentrations were measured using liquid chromatography-tandem mass spectrometry. The percentage and correlation between cord and maternal serum clarithromycin concentrations were calculated. Logistic regression analysis was performed to investigate the factors related to the cord and maternal serum clarithromycin concentration percentage. Results: A total of 34 cord-maternal serum pairs were included in the final analysis. The mean cord-maternal serum clarithromycin concentration percentage was 7.93±0.9%. There was a good correlation between cord serum and maternal serum clarithromycin concentration (r=0.795, P<0.001). The cord-maternal serum clarithromycin concentration percentage significantly increased according to advancing gestation (P<0.001). Conclusions: Our data showed that the mean placental transfer of clarithromycin is approximately 8% and dependent on gestational age. PMID:23095192
The purpose of our experiments was to examine the possible influence of the hypothalamus in supporting cellular proliferation, and thus adenoma growth. Fragments from four human pituitary adenomas were transplanted into the pituitary fossa of total-body irradiated, hypophysectomized rats. The rats were killed after two weeks and perfused with a mixture of formalin and India ink. Histologic examination of serial sagittal sections through the pituitary fossa and the adjacent brain showed: vascularization of the grafts from the pituitary stalk and from the scar tissue in the sphenoid bone; survival of some adenomas; and numerous mitoses in an ACTH-secreting specimen obtained from a patient who had Cushing's disease. We conclude from these experiments that as yet unidentified hypothalamic factors are essential for the growth of certain types of pituitary adenomas.
This is a report of adenoid cystic carcinoma occurred in the palate in 30-year-old patient with a complaint of exophytic mass.The authors diagnosed it as adenoid cystic carcinoma by the clinical examination, radiographic findings and histopathological findings. The obtained results are as follows: 1. In the clinical examination, asymptomatic exophytic mass of palate was observed. 2. In radiographic findings, soft tissue mass infiltrated the left maxillary sinus, nasal cavity, infraorbital fossa, hard palate, pterygopalatine fossa and pterygoid plate, and enhanced soft tissue mass was also observed in CT. 3. In histopathological findings, tubular and solid patterns of glandular structures were observed and the infiltration of tumor cells into the nerve fibers was also observed. 4. Two years after radical surgery, radiation therapy and chemotherapy, the perineural spread to orbital area was observed. 5. Much longer follow-up than 5 years is needed for early diagnosis of recurrence and distant metastasis.
AbstractObjectives/Hypothesis: The aims of this study were to demonstrate the surgical technique involved in the preauricular infratemporal fossa (ITF) approach, outline the clinical indications for use of this technique, and present the results in using this approach in 159 patients with malignant parotid tumors. At the conclusion of this article, the reader should be able to understand the utility of the preauricular infratemporal fossa approach in the management of patients with advanced malignant parotid tumors. Study Design: This was a retrospective chart review of 159 patients treated at a tertiary care academic medical center following institutional review board approval. Methods: A comprehensive medical records review was performed for all patients with malignant parotid tumors who...
Abstract in english A left paraduodenal hernia is a protrusion of the small intestine through the paraduodenal fossa, a congenital defect situated to the left of the fourth portion of the duodenum. Imaging studies often play a central role in diagnosing left paraduodenal hernias, as they are not easily identified clinically. Surgery is the treatment of choice. We report a case of left paraduodenal hernia in a 27-year-old female patient. The patient had shown no symptoms until six days before (more) hospitalization. A CT scan suggested the diagnosis of left paraduodenal hernia. After an unsuccessful laparoscopic attempt, a laparotomy was performed. Open surgery consisted in removing adhesions between the hernia and peritoneum, reducing jejunal loops and closing the paraduodenal fossa. The postoperative period was uneventful, and the patient was discharged on the third postoperative day.
Soft-tissue tophi can be observed in up to 50% of patients with primary gout. They are firm deposits of monosodium urate in crystal form, which develop from pinhead-size to egg-size in the subcutaneous tissue. In the field of ear, nose, and throat diseases tophi have been described in such rare locations as the wing of the nose, the tongue, the epiglottis, and the arytenoid and thyroid cartilage. Tophus formation at the temporomandibular joint with extension into the fossa infratemporalis has been mentioned only three times in the world literature. -In the present paper, the authors report on the extraordinary location of an urate tophus in the fossa infratemporalis - in this case, there was even destruction of the middle base of the skull - which had been misinterpreted for years, having been diagnosed as a primary disease of the parotid gland. PMID:2513816
Mucocele, though is a common lesion, rarely penetrates to the surrounding intra- and extracranial spaces. We describe the case of 45-year-old male with 2 years history of a chronic left nasal obstruction and a concentric visual field deficit in the left eye as the only manifestations. Diagnostic CT and MRI imaging revealed a mucocele originating from the posterior ethmoid and sphenoid sinuses and penetrating intracranially to the anterior and middle cranial fossae and extracranially to the pterygopalatine fossa and the parapharyngeal space. This extensive localization appears to be an extremely rare entity, which, to our knowledge, has not been described in the English literature yet. The clinical features and a literature review are also presented. PMID:20476593
Introduction Thromboembolic deterrent (TED) stockings are commonly used in the prevention of deep venous thrombosis. We would like to highlight a potential complication associated with the use of TED stocking. A 42-year-old paraplegic gentleman suffering from a complicated Ischial ulcer was admitted for debridement and closure with a fasciocutaneous rotational flap. Two weeks later, new pressure sores of the popliteal fossae of both his legs had developed. Clinical assessment revealed linear pressure sores in the presence of poorly fitted, tight, thigh-length TED stockings, which had rolled up at the popliteal fossa creating a focal linear compression in the presence of bilateral spastic flexed knees in this paraplegic patient. The TED stockings were immediately discontinued and the pressu...
INTRODUCTION: Thromboembolic deterrent (TED) stockings are commonly used in the prevention of deep venous thrombosis. We would like to highlight a potential complication associated with the use of TED stocking. A 42-year-old paraplegic gentleman suffering from a complicated Ischial ulcer was admitted for debridement and closure with a fasciocutaneous rotational flap. Two weeks later, new pressure sores of the popliteal fossae of both his legs had developed. Clinical assessment revealed linear pressure sores in the presence of poorly fitted, tight, thigh-length TED stockings, which had rolled up at the popliteal fossa creating a focal linear compression in the presence of bilateral spastic flexed knees in this paraplegic patient. The TED stockings were immediately discontinued and the pressure sores were managed with regular wound care and dressing change. CONCLUSION: We would like to highlight the complications that could arise amongst paraplegic patients with the widespread use of TED stockings. PMID:19633824
Abstract in portuguese Reportamos nossa experiência com o uso de uma minicraniotomia supra-orbitária através do supercílio para tratamento de lesões situadas na fossa anterior, cisterna supra-selar, para-selar e fissura de Sylvius. Uma incisão de 50 mm é realizada no supercílio, seguida de minicraniotomia. Dezesseis pacientes portadores de diferentes lesões foram operados e apresentaram bom resultado pós-operatório e também estético. Concluímos que esse acesso é seguro e útil em casos selecionados Abstract in english We report our experience with a supraorbital eyebrow minicraniotomy. This technique is suitable to lesions situated in the region of the anterior fossa, suprasellar cisterns, parasellar region and Sylvian fissure. A 50 mm incision in the eyebrow and a supraorbital minicraniotomy is performed. Sixteem patients harboring different lesions were operated on with good postoperative and cosmetic results. We conclude that this approach is safe and useful in selected cases.
Abstract Background/Aims: Posterior fossa tumors are the most common brain tumors in children. Surgeons usually remove these tumors via a midline incision through the posterior vermis of the cerebellum. Though often effective, this surgery causes hypotonia, ataxia, oculomotor deficits, transient mutism, difficulty in swallowing and nausea. To date, there is no animal model that mimics these complications. We found that the rhesus macaque is a good model for the consequences of this surgery. Methods: We made a midline incision through the cerebellar vermis of one monkey to mimic the posterior fossa surgery. Then, we closely monitored the monkey for deficits following the surgery. Results: In the first few days, the monkey exhibited nausea, hypotonia, ataxia, difficulty in swallowing and an ...
AbstractObjective To evaluate the accuracy of fetal imaging in differentiating between diagnoses involving posterior fossa fluid collections and to investigate the postnatal outcome of affected infants. Methods This was a retrospective study of fetuses with posterior fossa fluid collections, carried out between 2001 and 2010 in two referral centers for prenatal diagnosis. All fetuses underwent multiplanar neurosonography. Parents were also offered fetal magnetic resonance imaging (MRI) and karyotyping. Prenatal diagnosis was compared with autopsy or postnatal MRI findings and detailed follow-up was attempted by consultation of medical records and interview with parents and pediatricians. Results During the study period, 105 fetuses were examined, at a mean gestational age of 24 (range, 17-...
Chiari malformations 1, 2, 3 represent different degrees of herniation of posterior fossa content into the cervical canal (Chiari 1 and 2), or through an upper-cervical meningocele (Chiari 3), whereas Chiari 4 anomaly consists of hypoplasia of the cerebellum. Chiari 1 malformation (CM1) is the commonest anomaly; it is probably related to a mesodermal defect that create a congenitally small posterior fossa, subsequent overcrowding of its contents and herniation through the foramen magnum. The diagnosis of CM1 is based on the demonstration of the downward displacement and particular shape of the cerebellar tonsils into the upper cervical spinal canal associated with obliteration of the subarachnoid spaces at the level of the foramen magnum. MRI has a fundamental role in the correct identific...
Pilocytic astrocytoma sometimes transforms to a malignant type, and previous radiation therapy is considered to be a key factor. We report a case of pilocytic astrocytoma with histological malignant features without previous radiation therapy. A 21-year-old man presented a sudden onset of severe headache. Neuroimaging had detected a cystic mass in the posterior fossa at the age of one year without therapeutic intervention. On admission, computed tomography depicted a brain tumor in the posterior fossa with cystic components, intratumoral hemorrhage, and upward herniation. Urgent surgery was performed, and histological examination revealed some features of pilocytic astrocytoma but also broad necrosis, high cellularity, and MIB-1 labeling index of more than 20%. The histological diagnosis was pilocytic astrocytoma with malignant features. This tumor had continued a benign clinical course for 20 years, but had eventually transformed to a malignant type. Therefore, pilocytic astrocytoma may undergo spontaneous malignant transformation during its natural clinical course.
We present a case of a 72 year old male patient, who presented to the emergency department with a 2 day history of right iliac fossa pain. On examination he was apyrexial and haemodynamically stable, yet displayed signs of right iliac fossa peritonism. Inflammatory markers were mildly raised. Computed tomography and diagnostic laparoscopy both demonstrated typical features of epiploic appendagitis. Epiploic appendagitis is an uncommon cause of the acute abdomen, yet is probably underdiagnosed. The term was first used by Lynn et al. in the mid 1950s. With the increase in CT scanning and diagnostic laparoscopy, we feel that both surgeons and radiologists need to be increasingly aware of the clinical and radiological appearances of epiploic appendagitis. PMID:20457285
We report a case of anuria in a 42-year-old female kidney transplant patient that occurred secondary to extrinsic compression from a large kidney being placed extraperitoneally in a small iliac fossa. Prompt reexploration in the immediate postoperative period resulted in salvage of the graft with restoration of kidney function. The abdominal wall was reconstructed using prosthetic mesh, which decreased the compartment pressure within the iliac fossa sufficiently to allow the renal vein patency and the kidney perfusion. We think that this tension-free surgical technique should be applied in those cases in which the retroperitoneal space is less than the size of the kidney to avoid renal allograft compartment syndrome or incisional hernia. PMID:16757260
A 32-year-old man presented with an arachnoid cyst of the posterior fossa manifesting as cervical syringomyelic myelopathy. Magnetic resonance (MR) imaging demonstrated edematous enlargement and T2 prolongation of the cervical spinal cord, indicating a “presyrinx” state. MR imaging showed the inferior wall of the cyst, which disturbed cerebrospinal fluid (CSF) pulsatile movement between the intraspinal and intracranial subarachnoid spaces. The cyst wall was fenestrated with a neuroendoscope. The presyrinx state and the CSF movement improved. Posterior fossa arachnoid cyst, as well as Chiari malformation, can cause CSF flow disturbance at the craniocervical junction and syringomyelia. Endoscopic fenestration is less invasive than foramen magnum decompression and should be the procedure of choice.
We describe a 10-year-old boy with an intracranial lipoma in the posterior fossa. The patient had a subcutaneous tumor of the posterior neck at birth, which was gradually growing and subsequently accompanied by gait disturbance and ataxia. MR imaging revealed the intracranial lipoma in the posterior fossa extending into the cervical spinal canal and subcutaneous space via a cranium bifidum. A surgical operation was performed, but the lipoma could not be removed completely. He had had prominent obesity that might have caused not only enlargement of the intracranial lipoma but also neurological complications. Although intracranial lipomas are usually benign and asymptomatic, early detection of them is quite critical, and body weight control may help to prevent their progression.
We describe a 10-year-old boy with an intracranial lipoma in the posterior fossa. The patient had a subcutaneous tumor of the posterior neck at birth, which was gradually growing and subsequently accompanied by gait disturbance and ataxia. MR imaging revealed the intracranial lipoma in the posterior fossa extending into the cervical spinal canal and subcutaneous space via a cranium bifidum. A surgical operation was performed, but the lipoma could not be removed completely. He had had prominent obesity that might have caused not only enlargement of the intracranial lipoma but also neurological complications. Although intracranial lipomas are usually benign and asymptomatic, early detection of them is quite critical, and body weight control may help to prevent their progression. PMID:18378416
Abstract The hominoid right partial humerus IPS4334, from the middle Miocene (MN 8) of Castell de Barber (Valls-Peneds Basin, Catalonia, Spain), is described. It preserves the mid-distal portion of the shaft until the proximal margins of the radial and coronoid fossae, as well as the proximal portion of the olecranon fossa; the capitulum, the trochlea and the two epicondyles are missing. Although morphological comparisons are restricted, available evidence indicates that IPS4334 is more derived towards the modern hominoid condition than the Klein Hadersdorf specimen attributed to Griphopithecus (ca. 13-14 Ma), thus being most similar (except for its larger size and greater robusticity) to the presumably juvenile specimen of Dryopithecus fontani from Saint Gaudens in France (ca. 11-12 Ma). ...
ObjectiveTo review the microsurgical anatomy of Meckel's cave, a detailed knowledge of which is a prerequisite to devising an appropriate surgical strategy and performing successful surgery. MethodsThe microsurgical anatomy of Meckel's cave was studied under an operating microscope in 15 human cadaver heads (30 sides). To understand the meningeal architecture and the cross-sectional anatomy of Meckel's cave, serial histologic sections were made in an additional adult human cadaver specimen. ResultsMeckel's cave is a natural mouth-shaped aperture connecting with the posterior fossa that is located in the medial portion of the middle cranial fossa. The cave extends forward similar to an open-ended three-fingered glove and provides a channel for the rootlets of the trigeminal nerve; the trige...
Electric resistivity tomography (ERT), self-potential (SP), soil CO2 flux, and temperature are used to study the inner structure of La Fossa cone (Vulcano, Aeolian Islands). Nine profiles were performed across the cone with a measurement spacing of 20m. The crater rims of La Fossa cone are underlined by sharp horizontal resistivity contrasts. SP, CO2 flux, and temperature anomalies underline these boundaries which we interpret as structural limits associated to preferential circulation of fluids. The Pietre Cotte crater and Gran Cratere crater enclose the main hydrothermal system, identified at the centre of the edifice on the base of low electrical resistivity values (<20? m) and strong CO2 degassing, SP, and temperature anomalies. In the periphery, the hydrothermal activity is also visib...
Seventeen patients with 15 surgically proved paragangliomas involving the temporal bone and parapharyngeal spaces were examined with high-resolution computed tomography(CT). Scans were obtained in multiple axial (0/sup 0/,30/sup 0/) and coronal (70/sup 0/,105/sup 0/) section planes using 1.5-mm collimation and table incrementation. The purpose of this study was to demonstrate the utility of HRCT in assessing tumor extent and size, with particular emphasis on intrinsic temporal bone invasion. The most characteristic HRCT signs of paraganglioma include: jugular fossa expansion, soft-tissue mass in the hypotympanum and sinus tympani, permeation of the infracochlear surface, dural ballooning adjacent to the jugular fossa (indicative of epidural tumor), anterior displacement of parapharyngeal fat planes, and extension into the proximal aspect of the eustachian canal. It is concluded that HRCT is the single most efficacious examination to determine tumor extent, especially when intratemporal invasion has occurred, and to define other additional clinically unsuspected lesions.
Bacterial diversity of Fossa (pit) cheese during ripening and its related environment was investigated by culture-dependent and -independent methods. The dominant clones during cheese ripening, among 244 16S rRNA genes (rDNA), belonged to Firmicutes (99%) mainly affiliated with Lactococcus lactis and Streptococcus thermophilus starter species. Sequencing of 16S rDNA from 171 isolates cultured in M17 and MRS media showed an increasing occurrence of non-starter lactic acid bacteria (NSLAB) during ripening such as Lactobacillus plantarum, Lactobacillus casei, Lactobacillus paracasei, Lactobacillus fermentum, Lactobacillus rhamnosus. A greater diversity of NSLAB was found in the isolates than in the clone library. L. plantarum was the dominant species in Fossa cheese (42.9%). Bacterial species...
Epithelioid hemangioendothelioma (EHE) is a rare tumor of intermediate malignancy. We report a case of intracranial and intraorbitar EHE. A 3-year-old girl presented with a 3-month history of progressive left exophthalmia. Neuroradiologic imaging (CT scan and MRI) showed an intraorbitar process with an intense enhancement extending to temporal fossa, ethmoidal bone, nasal fossa, maxillary sinus, and cavernous sinus. The angiogram was normal. The tumor was operated through subfrontal approach but only a partial resection was performed. The histological diagnosis was epithelioid hemangioendothelioma. The patient was neurologically intact 2 months after surgery without exophtalmia. However 4 months after surgery he displayed a fall of the right eye vision with intense headache. Control CT scan showed persistence of important tumoral residue. Epithelioid hemangioendothelioma is a hemorrhagic tumor. Total removal must be possible. Otherwise, we recommend a complementary chemoradiotherapy and close followup. We propose this interesting case history of a tragical evolution of EHE in contradiction with what has already been reported.
We report on the case of an epidermoid cyst of the pterygopalatine fossa, which we operated on via the endoscopic transnasal approach, only the second one in the world to the best of our knowledge. A 67-year-old woman had discomfort in her left jaw when biting. MRI findings taken two years after the first medical examination showed that the cyst had gradually grown larger. In addition she started to show a symptoms of ipsilateral otitis media with effusion (OME). After the surgery the OME improved. There is a possibility that the OME had something to do with the compression of the cyst. The endoscopic transnasal approach is a safe, effective and less invasive therapeutic modality for treatment of cysts in the pterygopalatine fossa.
Objective: To study the relationship between current perception threshold (CPT) and somatosensory evoked potential (SEP) in diabetes. Methods: Both CPT and SEP were recorded in 66 diabetic patients. Both the CPT scores (measured at 2000Hz, 250Hz, and 5Hz stimulations) and SEP (peak latency at ERB's point [Lat ERB] and popliteal fossa [Lat PF]; interpeak latency of ''ERB to 7th cervical vertebra'' [Dlat ERB-C7] and ''popliteal fossa to lumbar vertebra'' [Dlat PF-FO]) were recorded in both upper and both lower limbs, separately. t-tests and correlation analyses were performed to assess relationships between CPT and SEP tests. Results: After adjustment for height and/or age, CPT scores at 2000Hz were significantly correlated with Lat ERB (left: =0.408, P<0.05; right: =0.297, P<0.05), Dlat ERB...
Background Coxa profunda, or a deep acetabular socket, is often used to diagnose pincer femoroacetabular impingement (FAI). Radiographically, coxa profunda is the finding of an acetabular fossa medial to the ilioischial line. However, the relative position of the acetabular fossa to the pelvis may not be indicative of acetabular coverage. Questions/purposes We therefore determined the incidence of coxa profunda and evaluated associations between coxa profunda and other radiographic parameters of acetabular coverage commonly used to diagnose pincer FAI and acetabular dysplasia. Methods We evaluated the radiographs of three cohorts for coxa profunda, lateral center edge (LCE) angle, acetabular index, posterior wall sign, and crossover sign. Data from 67 collegiate football players were colle...
Of 60 cases of dural arteriovenous malformations (DAVM) explored and treated in the Vascular Neuroradiology Unit of the Hospital of Bicetre between 1980 and 1986, 3 presented in an extrasinusal location: intraorbital, middle cerebral fossa and the region of the superior orbital fissure. We have not found any prior description of DAVMs in these regions in the literature. The classic concept that DAVMs rise in direct relationship with the dural sinuses is limited. We believe that these lesions may also developed in relationship with the venous drainage system of the sinuses and the venous drainage of the peripheral nervous system. We note that the superior ophthalmic vein which drains DAVMs of the orbit and the olfactory vein which drains DAVMs of the anterior cranial fossa and other veins that accompany the cranial nerves through the skull base have the characteristics of emissary veins. It may be that DAVMs can develop wherever veins follow a transosseous trajectory.
Background Trigeminal schwannomas are rare tumours accounting for 0.07?0.36% of all intracranial tumours and 0.8?8% of intracranial schwannomas. Symptoms and signs of these lesions depend on the site of the tumour, which may compress the nerve of origin or adjacent nerves. Case report We describe a case of a 69-year-old woman with a history of progressively worsening hypoesthesia involving the third division of the trigeminal nerve. A tumour of 5-cm diameter was revealed within the right cranial middle fossa, extending to the lateral wall of the cavernous sinus, the infratemporal fossa and the posterior wall of the maxillary sinus. A combined craniofacial approach was undertaken. A right extended subtemporal craniotomy was performed. The intracranial component of the tumour, originating fr...
Abstract in portuguese Aneurisma verdadeiro de artéria renal em rim transplantado é ocorrência rara. As possibilidades de tratamento dependem do tamanho, da localização do aneurisma e da clínica apresentada pelo paciente. Descreve-se um caso de aneurisma gigante de artéria renal em rim transplantado que recebeu tratamento ex vivo e reimplante na fossa ilíaca direita. Detalhes do procedimento cirúrgico são descritos. Abstract in english True aneurysm of a renal artery in a transplanted kidney is a rare occurrence. Treatment options depend on size and location of the aneurysm and the patient’s clinical condition. We report a case of a giant aneurysm of the renal artery in a transplanted kidney that was treated ex vivo and reimplanted in the right iliac fossa. Details of the surgical procedure are described.
Abstract Objective.- Trigeminal neuralgia is rarely caused by arteriovenous malformations of the posterior fossa. Embolization of aberrant vessels can provide symptomatic relief; however, embolization is not always technically possible, and its effects can be temporary. Embolization of the nerve's blood supply could reduce its excitability and provide pain relief. Setting.- The study was set in an academic tertiary care center. Study Design.- The study was designed as a report of a clinical case. Summary.- The authors report the case of a 13-year-old girl with a large, unruptured posterior fossa arteriovenous malformation (AVM) presented with left-sided V2-division trigeminal neuralgia. She had undergone multiple previous embolizations of feeding vessels from the anterior inferior cerebell...
Analysis of images from the Messenger MDIS narrow angle camera imply that at least part of the radial graben of the Pantheon Fossae structure, and probably the structure as a whole, predate the deformation that led to circumferential ridges on the Caloris interior plains. This follows from structural analysis and comparison with similar geological relationships on Venus and the Moon, where graben are known to both postdate and predate ridges. Observations suggest that the Pantheon Fossae radial graben (extension) formed first, pre-dating observed circumferential graben (also extension), with ridges (compression) formed in between. This scenario puts constraints on the models for the deformation of the Caloris basin and its vicinity. Our observations and analysis are consistent with Pantheo...
The posterior fossa syndrome (PFS) consists of transient cerebellar mutism, cognitive symptoms and neurobehavioural abnormalities that typically develop in children following posterior fossa tumour resection. Although PFS has been documented in more than 350 paediatric cases, reports of adult patients with a vascular aetiology are extremely rare. In addition, the pathophysiological substrate of the syndrome remains unclear. We report an adult patient with PFS after surgical evacuation of a cerebellar bleeding. After 45 days of (akinetic) mutism, the patient's cognitive and behavioural profile closely resembled the "cerebellar cognitive-affective syndrome". A quantified SPECT study showed perfusional deficits in the anatomoclinically suspected supratentorial areas, subserving language dynamics, executive functioning, spatial cognition and affective regulation. We hypothesize that cerebello-cerebral diaschisis might be an important pathophysiological mechanism underlying akinetic mutism, cognitive deficits and behavioural-affective changes in adult patients with PFS. PMID:22038693
Purpose Cerebellar mutism is a common complication of posterior fossa surgery in children. This article reviews current status with respect to incidence, anatomical substrate, pathophysiology, risk factors, surgical considerations, treatment options, prognosis and prevention. Methods We reviewed all peer-reviewed English publications on cerebellar mutism between the years of 1985 and 2009. The majority were found by searching for ?cerebellar mutism? and ?posterior fossa syndrome? in PubMed. Additional cases were identified by cross-checking reference lists. Results The overall incidence of postoperative cerebellar mutism is 11?29%, and patients with medulloblastomas and/or brainstem invasion are at a greater risk of developing it than those with other kinds of tumors and/or without brainst...
The aim of this study is to identify possible risks factors for the occurrence of cerebellar mutism syndrome (CMS) in children with posterior cranial fossa tumours. Children diagnosed with posterior fossa tumours consecutively admitted to our institution between 2006 and 2008 were the subjects of this prospective study. Besides standard neurological and radiological evaluations, all children underwent thorough neuropsychological assessments at admission and following surgery. Children under two or older than 16?years of age and those with a severe pre-operative clinical condition precluding neuropsychological assessment were excluded. Thirty-four children met the inclusion criteria. They were divided into two groups. Group I consisted of 23 children with normal language on admission and gr...
The posterior fossa syndrome (PFS) is common after cerebellar tumor resection in pediatric patients. It is characterized by postoperative mutism and ataxia and associated with persistent abnormalities in mood and cognition. Method: A 2-year prospective study of children and adolescents with cerebellar tumors identified by neuroimaging was performed at the Children's Hospital Los Angeles. Results: There were 8 girls and 14 boys in the study, aged 14 months to 17 years. The tumor sizes ranged from 2 to 6.5 cm in diameter. The patients presented with ataxia, headache, vomiting, depressed or irritable mood and inattention. Symptoms of PFS were present postoperatively in all except for the 2 patients with lateral tumors. The symptoms began before resection, were most prominent immediately after surgery, and improved over time. Neuropsychological assessment of 10 patients documented a persistent cognitive decrement. Conclusion: This small, descriptive study provides information on the natural history of pediatric posterior fossa tumors from before surgery through the postoperative period. PMID:22832661
Thirty-six proven cases of medulloblastoma were reviewed by serial CT follow-up examinations from 4 months to 10 years, 2 months after the initial diagnosis, with a mean follow-up time of 3 years, 9 months. The tumor recurred at the primary site in 20 cases (56%). Leptomeningeal metastasis was demonstrated on CT in 14 cases (39%); seven of these patients also presented with solid subarachnoid metastases. Thirteen patients (36%) showed evidence of severe brain atrophy, which was confined to the posterior fossa in seven of the 13. Calcification resulting from mineralizing microangiopathy developed in five cases (14%), including three patients who had had extensive dystrophic calcification in the corticomedullary junction and the deep-seated nuclei of the cerebrum and cerebellum. The patterns of tumor recurrence in the posterior fossa that is severely deformed by surgery and other treatment modalities and leptomeningeal spread of tumor are discussed.
From 1972 to 1992, 15 patients with medulloblastoma have been treated with surgery and post-operative radiotherapy. Whole central nervous system (CNS) irradiation followed by boost to posterior fossa was used as a standard treatment. Various dose schedules were used. The 5 and 10 years disease free survival was 43% and 33%, respectively. In 7 patients who received grossly total resection and radiotherapy, only one patient relapsed 106 months after treatment. All of 8 patients who received partial resection or biopsy followed by radiotherapy have died with the median survival of 16 months. Diagnostic procedures, total dose of radiation to the posterior fossa, and technical factors of whole CNS irradiation were suggested to be prognostic factors. Mental retardation was observed in two patients who received whole brain irradiation of 35 Gy. Five out of 6 patients who survived more than 3 years experienced growth retardation. (author).
Thirty-three children under age 20 with medulloblastoma, treated between 1962 and 1976, at the University of California and the Claire Zellerbach Saroni Tumor Institute of Mount Zion Hospital, San Francisco, were retrospectively studied. A relationship between dose and local control rate was suggested by an improved five-year survival in those patients receiving doses greater than 5000 rads to the posterior fossa. The posterior fossa, either alone or with the spinal cord, was the most frequent site of failure. Results of re-irradiation for failure were encouraging and no significant complications were noted. A study of the effects of craniospinal irradiation on the hematopoietic and immune system demonstrated a marked decrease in the peripheral lymphocyte population at the completion of therapy and suggested a functional impairment of the remaining lymphocytes. Other side effects of irradiation included suppression of the hypothalamic-pituitary axis and one instance of brain necrosis. Current treatment policy and proposals for future modifications are discussed.
Aim The management of arachnoid cysts (AC) remains controversial. An additional problem derives from the management of hydrocephalus associated with an AC. In this work, we discuss existing procedures proposed in the current literature for their treatment. Methods We reviewed selected reports on intracranial ACs placing special interest in those about the association of hydrocephalus and ACs. We also briefly surveyed data of our patients with this association. Results and discussion Hydrocephalus is often found in midline and posterior fossa ACs. Interhemispheric lesions may also evolve with ventriculomegaly, while middle fossa lesions rarely produce hydrocephalus. Patients? age, cyst location and size, and macrocephaly have all been related to the development of hydrocephalus. Some author...
Abstract Venepuncture may be associated with nerve injuries and is commonly performed at the median cubital vein (MCV). Injuries to the superficial radial nerve at the wrist and to the median nerve, anterior and posterior interosseus nerves and medial and lateral cutaneous nerves (LCN) of the forearm at the cubital fossa have been reported. The LCN is a sensory branch of the musculocutaneous nerve and the position of the nerve in relation to the MCV is variable within the cubital fossa. The LCN supplies sensory innervation to the C6 dermatome corresponding to an area of skin overlying the radial border of the forearm. We report the case of a 30-year-old right-handed woman who presented with loss of sensation in the left forearm after donating blood at a transfusion centre. This was due to ...
We describe an anatomical variation of the right maxillary artery, discovered during dissection of a male human cadaver. The right maxillary artery bifurcates into unequal superficial (larger) and deep (smaller) divisions. Each division gives off several branches that distribute to the muscles of mastication, facial structures, and teeth. The superficial and deep divisions then reunite to form a complete loop, before giving off terminal branches in the pterygopalatine fossa. The entire arterial loop lies superficial to the branches of the mandibular nerve. This case provides further evidence for a network of vascular rings that surround soft tissue structures in the developing infratemporal fossa. Persistence of all or part of these rings determines adult anatomy. Extreme anatomical variat...
This report summarizes the status of mapping projects supported by NASA grant NNX07AP42G, through the Planetary Geology and Geophysics (PGG) program. The PGG grant is focused on 1:2M-scale mapping of portions of the Medusae Fossae Formation (MFF) on Mars. Also described below is the current status of two Venus geo-logic maps, generated under an earlier PGG mapping grant.
This report summarizes the status of mapping projects supported by NASA grant NNX07AP42G, through the Planetary Geology and Geophysics (PGG) program. The PGG grant is focused on 1:2M-scale mapping of portions of the Medusae Fossae Formation (MFF) on Mars. Also described below is the current status of two Venus geologic maps, generated under an earlier PGG mapping grant.
Abstract in portuguese Os autores relatam o caso de um paciente masculino, de 25 anos, admitido com história de dor em cólica na fossa ilíaca esquerda há duas semanas, distensão abdominal, diarréia mucóide e anorexia. Evoluiu com instabilidade hemodinâmica, uma massa endurecida era palpada na fossa ilíaca esquerda com sinais de irritação peritoneal. Na laparotomia, foram encontrados peritonite fecal e uma perfuração do cólon sigmóide. Realizada hemicolectomia esquerda com colosto (more) mia terminal. O exame anátomo-patológico revelou espessamento da parede do cólon com estreitamento de sua luz e múltiplos pólipos na mucosa. O exame histopatológico confirmou a causa da obstrução como colite granulomatosa crônica com ovos viáveis de Schistosoma mansoni. Este é o primeiro caso de obstrução colônica complicada com perfuração causada por esquistossomose mansônica relatado na literatura consultada. Abstract in english The authors report a case of a 25 year old Brazilian man with a history of crampy abdominal pain in the left iliac fossa for 2 weeks, abdominal distention, mucous diarrhea and anorexia. The patient presented signs of hemodynamic instability and a hard mass palpated in the left iliac fossa presented peritoneal irritation. At laparotomy, fecal peritonitis and a punched-out perforation of the midsigmoid colon were found. A left hemicolectomy was performed with terminal colos (more) tomy. Specimen examination revealed a thickened rectosigmoid wall, narrow lumen and multiple mucosal polyps. Microscopically, chronic granulomatous colitis with Schistosoma mansoni eggs confirmed the etiology. To the authors' knowledge, this is the first case of obstruction complicated with perforation due to mansoni schistosomiasis reported in the literature.
A 33-year-old man with no history of trauma or surgery was seen for a posterior ethmoidal sinus cyst with intracranial development, causing headaches. He also had anterior cranial fossa bone defects. Computed tomography and magnetic resonance imaging confirmed a cyst in the left posterior ethmoidal sinus, necessitating endoscopic sinus surgery under general anesthesia, to open the cystic lesion and drain mucus secretion. The postoperative course in the 14 months since surgery has been uneventful.
Situs inversus with mirror-image of the heart is a rare condition. The present report describes a case of a patient with dextrocardia with situs inversus who had atrial septal defect with multiple holes in the fossa ovalis. The patient underwent total endoscopic atrial septal defect repair using the da Vinci surgical system. This procedure was achieved safely with good clinical and excellent cosmetic results. PMID:22200951
Abstract This clinical report describes a multidisciplinary approach in the rehabilitation of a 23-year-old Caucasian woman affected with Turner's syndrome and subsequently diagnosed with T4 Giant cell reparative granuloma of the right maxillary sinus. The surgical treatment included a maxillectomy and infratemporal fossa dissection followed by a free fibula palatal reconstruction, fibula bone graft of the orbital floor, dental implant placement, and prosthodontic rehabilitation. Prosthodontic planning and treatment considerations in an adult patient with Turner Syndrome are discussed.
Investigation of frontal brain sections of 10 cats, 30 dogs and 20 people revealed a topographic correlation between certain cortical and subcortical structures: the beginning of fissura. Sylvii (the so-called "fossa Sylvii") and commissura alba cerebri anterior are located always in the same stereotaxic frontal plane. A method of practical application of the revealed topographic correlation is suggested for the stereotaxic operations on higher animals and human beings. PMID:1264297
Nuclear magnetic resonance scans (NMR-CT) were performed on patients with posterior fossa disorders such as acoustic neurinoma, cerebellar tumour (gangliocytoma), epidermoid tumour and spinocerebellar degeneration, and compared with X-ray computed tomography (CT) scans. The advantages of NMR-CT include lack of bone artifact, variety of image planes, transverse, sagital and coronal imaging, and high ability to differentiate tissues. The disadvantages include prolonged data accumulation time, lack of bone detail and calcification, limited spatial resolution and suitability of patients. (author).
Extra-axial cavernous haem angiomas are uncommon lesions histologically identical to cavernomas in other locations. However, their radiological features and clinical behaviour may differ. They are frequently misdiagnosed preoperatively, as they often mimic other tumours. We describe a patient suffering from loss of the sense of smell, due to a cavernous haemangioma implanted in the dura mater of the anterior cranial fossa close to the olfactory bulb. To our knowledge, this is the first patient reported with such a lesion.
The Noachian terrain west of the Isidis basin hosts a diverse collection of alteration minerals in rocks comprising varied geomorphic units within a 100,000 km2 region in and near the Nili Fossae. Prior investigations in this region by the Observatoire pour l'Min??ralogie, l'Eau, les Glaces, et l'Activit?? (OMEGA) instrument on Mars Express revealed large exposures of both mafic minerals and iron magnesium phyllosilicates in stratigraphic context. Expanding on the discoveries of OMEGA, the Compact Reconnaissance Imaging Spectrometer for Mars (CRISM) aboard the Mars Reconnaissance Orbiter (MRO) has found more spatially widespread and mineralogically diverse alteration minerals than previously realized, which represent multiple aqueous environments. Using CRISM near-infrared spectral data, we detail the basis for identification of iron and magnesium smectites (including both nontronite and more Mg-rich varieties), chlorite, prehnite, serpentine, kaolinite, potassium mica (illite or muscovite), hydrated (opaline) silica, the sodium zeolite analcime, and magnesium carbonate. The detection of serpentine and analcime on Mars is reported here for the first time. We detail the geomorphic context of these minerals using data from high-resolution imagers onboard MRO in conjunction with CRISM. We find that the distribution of alteration minerals is not homogeneous; rather, they occur in provinces with distinctive assemblages of alteration minerals. Key findings are (1) a distinctive stratigraphy, in and around the Nili Fossae, of kaolinite and magnesium carbonate in bedrock units always overlying Fe/Mg smectites and (2) evidence for mineral phases and assemblages indicative of low-grade metamorphic or hydrothermal aqueous alteration in cratered terrains. The alteration minerals around the Nili Fossae are more typical of those resulting from neutral to alkaline conditions rather than acidic conditions, which appear to have dominated much of Mars. Moreover, the mineralogic diversity and geologic context of alteration minerals found in the region around the Nili Fossae indicates several episodes of aqueous activity in multiple distinct environments. Copyright 2009 by the American Geophysical Union.
BACKGROUND: We present two cases of children who were diagnosed with cerebellitis with acute cerebellar swelling. This rare pathology is potentially fatal, and no clear treatment guidelines are described in the literature. DISCUSSION: Considering our experience, we discuss the different therapeutic strategies and propose aggressive surgical measures consisting of external ventricular drainage and posterior fossa decompression in case of failure of early response to medical treatment to limit secondary cerebellar and brainstem lesions. PMID:15928964
Neurenteric cysts are cystic masses lined by a columnar epithelium of endodermal origin. They are rare in the central nervous system. We report two neurenteric cysts in the posterior cranial fossa and describe their neuroradiological features. The lesions were of low density on CT and more accurately delineated on MRI. They gave the same signal as cerebrospinal fluid on all sequences. There was no contrast enhancement. (orig.) With 2 figs., 13 refs.
Two spindle cell lipomas, one in the subcutis of the posterior neck and the other in the deeper site of the right supraclavicular fossa below the brachial plexus, were studied by light and electron microscopy. Both were histologically composed of a mixture of mature lipocytes and uniform spindle cells within mucinous matrix associated with scattered birefringent collagen fibers. Ultrastructural observation revealed lipid droplets and discontinuous extracellular lamina in the small part of the spindle cells, indicating the earliest differentiation towards adipocyte. PMID:2612340
Validity of regional blood flow (rCBF) measurements recorded over the human posterior fossa after 133Xe inhalation was tested. Recording of counts from both brain stem and cerebellum (BSC) was reproducible and contamination by counts derived from surrounding anatomical structures was low and no greater than that found over hemispheres. BSC flow values showed significant correlation with the state of awareness as judged by clinical and EEG evaluation.
The neurilemmoma of the pterygoid fossa are very rare. The authors reports one case of a 32 years old man, with such a neoplasm, exteriorized on the lateral facial region (area of the glandula parotis) clinical and radiological data could not differentiate benign neurilemmoma or slow evolutive sarcoma and have justified a conservative latero facial approach of the neoplasm. The final diagnosis of ancient neurilemmoma was based on both light and electron microscopy morphology. PMID:2291086
Abstract in english Progressive multifocal leukoencephalopathy is a neurological infectious disease caused by the John Cunningham polyomavirus (JCV), an opportunistic agent with worldwide distribution. This disease is frequently seen in immunosuppresed patients and rarely associated with systemic lupus erythematosus. In the central nervous system PML demyelinating lesions occur in the supratentorial compartment. The authors describe a rare case of PML secondary to SLE treatment with atypical presentation restricted to the posterior fossa.
This book presents a survey of the various imaging tools with examples of the different diseases shown best with each modality. It includes 100 case presentations covering the gamut of brain diseases. These examples are grouped according to the clinical presentation of the patient: headache, acute headache, sudden unilateral weakness, unilateral weakness of gradual onset, speech disorders, seizures, pituitary and parasellar lesions, sensory disorders, posterior fossa and cranial nerve disorders, dementia, and congenital lesions.
A case is reported of aortocaval fistula (ACF) as an infrequent complication of an aneurysm of the abdominal aorta (AAA) that debuted clinically with pain in the right lumbar fossa and kidney failure. the diagnosis was made by helicoid computed tomography (HCT) and confirmed surgery. HCT findings consisted of an early accentuation of the inferior vena cava (ICV) in the arterial phase, and visualization of the communication between the aorta and inferior vena cava. (Author) 8 refs.
To compare and evaluate the diagnostic ability of cone beam computed tomography (CBCT) and magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ). CBCT and MRI of 46 TMJs of 23 patients with TMJ disorders were evaluated. They were divided into 3 groups according to the position of the articular disc of the TMJ at closed mouth position and the reduction of the disc during open mouth position on MRI: no disc displacement group (NDD), disc displacement with reduction group (DDR), and disc displacement without reduction group (DDWR). With PACS viewing software, position of mandibular condyle in the articular fossa, osseous change of mandibular condyle, shape of articular fossa, and mediolateral and anteroposterior dimensions of mandibular condyle were evaluated on CBCT and MRI. Each value was tested statistically. The position of mandibular condyle in the articular fossa were concentric in the NDD, DDR, and DDWR of CBCT and NDD of MRI. However, condyle was positioned posteriorly in DDR and DDWR of MRI. Flattening, sclerosis and osteophyte of the mandibular condyle were much more apparent on DDR of CBCT than MRI. And the erosion of the condyle was much more apparent on DDWR of MRI than CBCT. Box and Sigmoid types of articular fossa were found most frequently in DDR of MRI. Flattened type was found most frequently in DDR of CBCT and deformed type was found most frequently in DDWR of CBCT. No significant difference in mediolateral and anteroposterior dimensions were shown on CBCT and MRI. Since MRI and CBCT has unique diagnostic imaging ability, both modalities should be used together to supplement each other to evaluate TMJ.
Mammary-type myofibroblastoma is a very rare, benign, spindle cell lesion, arising mainly in the inguinal region. This clinical entity strictly duplicates the features of its breast counterpart. To our knowledge, this is the first report of this particular lesion occurring in the popliteal fossa. We discuss the clinical, radiological and histopathological features of this case, emphasizing the role of incisional biopsy in such an unusual neoplasia. (orig.)
We report four patients in whom gas was seen in the head on CT shortly after cardiopulmonary resuscitation. The gas was in the posterior cranial fossa, presumably within veins, or in the cavernous sinus. The cause of the cardiac arrest was myocardial infarction in three patients and hanging in one. All had peripheral or central venous lines. The mechanism by which gas appeared in the intracranial veins is discussed. (orig.) With 5 figs., 14 refs.
We present two cases of spontaneous intracerebellar migration of a pseudomeningocele. This is a rarely reported complication of posterior fossa surgery with possible life threatening cerebellar mass effect. The probable mechanism is a slow but progressive cerebrospinal fluid (CSF) movement (one-way valve mechanism) into the pseudomeningocele with secondary herniation or dissection through a weakened dura into the cerebellum causing progressive or acute cerebellar dysfunction. Evacuation and dural repair with or without CSF shunting or marsupialisation results in resolution of the symptoms.
A 71-year-old woman presented with the symptoms of a posterior cranial fossa mass. CT and MRI revealed a lytic lesion in the occipital bone and a tumour infiltrating the dura mater, venous sinuses and cerebellum. Histopathology demonstrated a moderately differentiated squamous cell carcinoma arising from a primarily intradiploic epidermoid cyst. Despite surgery and radiotherapy, the tumour progressed and the patient died 1 year later. (orig.) With 4 figs., 11 refs.
Luxatio erecta or inferior dislocation of the shoulder joint is rare and is caused by a hyperabduction injury. The clinical appearance is characteristic, with the arm locked in an elevated position. Radiographically, the shaft of the humerus is directed upwards and the humeral head lies inferior to the glenoid fossa, although not in contact with it. Attention should be given to possible complication, particularly concurrent fractures, as well as injury to the brachial plexus or the axillary artery.
A 30-year-old woman who had a destructive Mycobacterium avium complex infection in the left inguinal fossa affecting the pubic bone underwent three-phase bone scanning to identify other possibly affected sites. Multiple skeletal lesions were seen scattered throughout the vertebral column, sternum, and pelvis. This case is presented to describe a rare extensive metastatic M. avium complex infection in an immunocompromised patient. PMID:12045433
The aim of this study is to identify possible risks factors for the occurrence of cerebellar mutism syndrome (CMS) in children with posterior cranial fossa tumours. Children diagnosed with posterior fossa tumours consecutively admitted to our institution between 2006 and 2008 were the subjects of this prospective study. Besides standard neurological and radiological evaluations, all children underwent thorough neuropsychological assessments at admission and following surgery. Children under two or older than 16 years of age and those with a severe pre-operative clinical condition precluding neuropsychological assessment were excluded. Thirty-four children met the inclusion criteria. They were divided into two groups. Group I consisted of 23 children with normal language on admission and group II had 11 children showing pre-operative language impairment (PLI). PLI was observed in 11 children (32.4%: group II). Post-operatively, seven out of 34 children developed CMS (20.6%), all of them belonging to group II. In group II, indeed, the incidence of CMS was 63%. No case of CMS was observed in group I. PLI regressed after the operation in three out of the four subjects belonging to group II who did not develop CMS. PLI remained unchanged in the last child of this group. Posterior fossa tumour resection can have different effects on children with pre-existing language impairment (PLI). PLI can be considered a subclinical state of CMS in some children with posterior fossa tumour. However, in some children with PLI, the tumour resection may improve the linguistic abilities, as well as the other neurocognitive performances. In the present series, children with normal pre-operative language function did not develop post-operative mutism. PMID:21476131
Cerebellar mutism syndrome (CMS) is an important medical challenge in the management of pediatric posterior fossa brain tumors, because it occurs in a subset of children following tumor resection. A definitive clinical profile and neuroanatomical substrate associated with CMS remains unclear. We investigated the relationship between presurgical and clinical variables and the incidence of CMS, along with diffusion tensor imaging, to characterize the integrity of cerebello-thalamo-cerebral white matter pathways. Seventeen children with posterior fossa tumors and CMS, 34 children with posterior fossa tumors without CMS, and 28 healthy children were enrolled in this study. Bilateral cerebello-thalamo-cerebral pathways were delineated and segmented into anatomical regions. Mean integrity measures for each region were compared among children with CMS, children without CMS, and healthy children. Left-handedness, medulloblastoma histology, and larger tumor size distinguished between patients with CMS and patients without CMS (P < .04). Right cerebellar white matter within the cerebello-thalamo-cerebral pathway was compromised in children with CMS relative to children without CMS and healthy children (P < .02). We provide a potential schema for CMS risk among children treated for posterior fossa tumors. Left-handed children treated for medulloblastoma may be the most at risk for CMS, and unilateral, localized damage within the cerebello-thalamo-cerebral pathway at the level of the right cerebellum is implicated in the presentation of CMS. This disruption in communication between the right cerebellum and left frontal cortex may contribute to speech-language problems observed in children with CMS. Our findings may be relevant for surgical planning and speech-language therapy to mitigate symptoms of CMS. PMID:22952198
A young woman had a frontal lobe astrocytoma 14 years after successful treatment of a posterior fossa medulloblastoma by surgery and whole-neuraxis irradiation. The association of these two tumors is rare, and it is unlikely that the second tumor was the result of metastasis and differentiation of residual or recurrent medulloblastoma. We review the evidence supporting this view and also the likelihood that the astrocytoma was induced by the prior radiation.
Nevoid basal cell carcinoma syndrome (NBCCS, Gorlin syndrome) is an autosomal dominant condition with a wide range of manifestations, including multiple basal cell carcinomas, medulloblastoma, odontogenic keratocysts (OKC) and skeletal abnormalities. Children with NBCCS also have a predisposition for secondary cancers after exposure to ionising radiation. In children undergoing imaging for posterior fossa mass and/or maxillofacial cysts, certain additional findings can raise the possibility of NBCCS. Making the diagnosis can significantly impact patient management, especially for children with medulloblastoma. PMID:23151728
Abstract Posterior fossa syndrome (PFS), also known as cerebellar affective syndrome, is characterized by emotional lability and decreased speech production following injury or surgery to the cerebellum. Rarely, oculomotor dysfunction has been described in association with PFS. Here, we report a case of complete ocular paresis associated with PFS in an 11-year-old male following medulloblastoma resection. Copyright Copyright 2012 S. Karger AG, Basel
Skull morphology was compared between juvenile and adult green turtles by geometric morphometrics. The size of the orbit and length of the supraoccipital in relation to the centroid size were larger in juveniles than in adults, while the relative sizes of the infratemporal fossae and parietal were larger in the latter than in the former. The difference in the relative length of the supraoccipital did not predict the maintenance of functional equivalence of trophic structures, probably reflecting a functional trophic change with growth.
A backward distraction osteogenesis (BDO) of the condylar segment for treatment of mandibular ramus deficiency was developed. This report describes the clinical progress of a patient with mandibular ramus deficiency in whom satisfactory occlusion was achieved and maintained by gradual posterosuperior repositioning of the displaced condyles into the glenoid fossae during intermaxillary fixation. Findings of pre- and postoperative clinical and magnetic resonance imaging indicate that the effect of BDO on the temporomandibular joint was negligible. PMID:15243466
Nasopharyngeal angiofibroma (NA) is a rare, vascular tumor affecting adolescent males. Due to aggressive local growth, skull base location and risk of profound hemorrhage, NA is a challenge for surgeons. Angiofibromas have been sporadically described in extanasopharyngeal locations. We review ten cases of extranasopharyngeal angiofibroma (ENA) and discuss the incidence, clinical presentation and management of this pathology. The group consisted of 4 males and 5 females aged 8-49. There were 7 patients with nasal angiofibroma, 1 patient with laryngeal angiofibroma, 1 patient with oral angiofibroma and another patient with infratemporal fossa tumor. In patients with nasal angiofibroma most common presenting symptoms were nasal obstruction and epistaxis. Patients with laryngeal angiofibroma suffered from mild dysphagia and patients with the infratemporal fossa tumor had painless cheek swelling. In four patients with nasal tumor computed tomography (CT) demonstrated mass with strong to intermediate contrast enhancement. In one patient with nasal tumor carotid angiography demonstrated pathological vessels without intensive tumor blush. Infratemporal fossa tumor showed intensive contrast enhancement on CT and magnetic resonance imaging (MRI) scans, and abundant vascularity on angiography. Laryngeal and oral angiofibroma required no radiological imaging. Three nasal tumors were evaluated before introduction of CT to clinical practice. All patients underwent surgery. No recurrences developed. ENAs differ significantly from NAs regarding clinical and radiological presentations. They lack typical clinical and radiological features as they develop in all age groups and in females, may be less vascularised, arise from various sites and produce a variety of symptoms. PMID:22584751
[figure removed for brevity, see original site] (Released 29 July 2002) This THEMIS visible image covers a portion of the Medusa Fossae formation, near the equator of Mars. The most characteristic feature of the Medusa Fossae formation is the abundance of 'yardangs', which are erosional landforms carved by the wind. These features usually form in a linear fashion, and can be indicators of prevailing paleowind directions. On Earth, yardangs are typically found in rocks that are easily eroded, such as those that form from consolidated volcanic ash, dust-fall deposits or lake sediments. In this particular area of Medusa Fossae, the size, spacing, and orientation of the yardangs varies throughout the image. The largest form a stripe across the center of the image, while the smallest are found in the top half of the image (look closely). The small yardangs at the very top of the image are oriented NW-SE; however, the orientation changes to NE-SW near the bright ridge in the center of the image. The variation in size and orientation appears to correspond with topographic layers, and may be due either to differences in consolidation or changes in wind strength or direction as the yardangs were formed. Finally, the terrain in the lower third of the image appears etched or pitted, and was probably also formed by wind erosion.
The lacrimal fossa can be involved by a wide spectrum of orbital pathology. The correct diagnosis is important to avoid unnecessary procedure and to do appropriate management. 14 patients with mass lesions in the lacrimal fossa were evaluated with computed tomography (CT) and clinical findings. The results were as follows: 1. Final diagnosis of 14 cases with lacrimal fossa tumors was pleomorphic adenoma in 3 cases, adenoid cystic carcinoma in 1 case, pseudotumor in 5 cases, lymphoma in 2 cases, neurofibroma in 1 case, chloroma in 1 case and metastatic adenocarcinoma in 1 case. 2. The duration of symptoms of pleomorphic adenoma was more than 1 year and characteristic CT findings were globular masses with pressure erosion of the adjacent bone. Patient with adenoid cystic carcinoma had a short history of symptoms. CT showed a fusiform mass but intracranial extension with frank destruction of sphenoid bone. 3. Patients with pseudotumor and lymphoma had symptoms for less than 1 year. The CT findings were ill-defined infiltrative patterns with scleral thickening and the differential diagnosis of them was difficult. 4. The margins of neurofibroma and chloroma were well defined while that of the metastic adenocarcinoma was ill-defined. 5. The degree and the extent of the contrast enhancement gave no benefit in the differential diagnosis of each disease entities and even of the benign and malignant lesions.
Male mice deleting the gene encoding GOPC (Golgi-associated PDZ- and coiled-coil motif-containing protein) are infertile, showing globozoospermia with a coiled tail (Yao et al., 2002). We confirmed how and where tail anomalies were produced in spermatids and epididymal spermatozoa by light and electron microscopy. During spermiogenesis, tail formation occurred normally, but a defect was found at the posterior ring. Thereafter, remarkable sperm tail deformations were induced during epididymal passage. In the proximal caput epidiymidis, the tails remained normal and straight, but most of them coiled around the nucleus in the cauda epididymidis. Coiling is presumed to occur with the migration of the cytoplasmic droplet by the absence of the posterior ring. The connecting piece of the coiled tail was often dislocated or separated from the implantation fossa. Many mitochondria were separated from the outer dense fibers (ODFs) and formed a stratified mitochondrial sheath. Due to this, the distal part of the midpiece became bared of the mitochondrial sheath. The bared ODFs were often bent and disorganized. Tail deformities are attributed to weak or incomplete adhesion between the following structures: 1) plasma membrane and nuclear envelope at the posterior ring, 2) connecting piece and implantation fossa, and 3) mitochondria and ODFs. These defects result in a coiled tail, tail dislocation from the implantation fossa, and the stratified mitochondrial sheath accompanying bared ODFs in the midpiece, respectively. Thus the posterior ring is significant in preventing coiled tail formation. The GOPC-deficient spermatozoa provide a valuable model not only for head but also for tail anomalies.
In mental retardation (MR) an aetiological diagnosis is not always obtained despite a detailed history, physical examination and metabolic or genetic investigations. In some of these patients, MRI is recommended and may identify subtle abnormal brain findings. We reviewed the cerebral MRI of children with non-specific mental retardation in an attempt to establish a neuroanatomical picture of this disorder. Thirty children with non-specific MR were selected to undergo cerebral MRI. The examination included supratentorial axial slices, mid-sagittal images and posterior fossa coronal images. Brain malformations, midline and cerebellar abnormalities were studied. In 27 of 30 patients, the neuroimaging evaluation revealed a relatively high incidence of cerebral and posterior fossa abnormalities. The most frequent were: dysplasia of the corpus callosum (46%; hypoplasia, short corpus callosum and vertical splenium), partially opened septum pellucidum and/or cavum vergae (33%), ventriculomegaly (33%), cerebral cortical dysplasia (23%), subarachnoid space enlargement (16.6%), vermian hypoplasia (33%), cerebellar and/or vermian disorganised folia (20%), and subarachnoid spaces enlargement in the posterior fossa (20%). Other anomalies were: enlarged Virchow-Robin spaces (10%), white matter anomalies (10%) and cerebellar or vermian atrophy. MRI has shown a high incidence of subtle cerebral abnormalities and unexpected minor forms of cerebellar cortical dysplasia. Even if most of these abnormalities are considered as subtle markers of brain dysgenesis, their role in the pathogenesis of mental retardation needs further investigation. (orig.)
Abstract in portuguese Foi realizada a verificação da presença de Staphylococcus aureus enterotoxigênico, em manipuladores de alimentos, em cozinhas hospitalares. Foi colhido material da porção anterior das fossas nasais de 34 pessoas que trabalhavam em três hospitais da cidade de São Paulo. Dentre os indivíduos examinados, 12 (35,3%) revelaram-se portadores de S. aureus e, destes 2 (16,7%) foram positivos para cepas produtoras de enterotoxina estafilocócica do tipo C. Das 12 cepas is (more) oladas, 9 (75%) foram fagotipáveis; das duas cepas enterotoxigênicas, uma foi não fagotipável e a outra foi Usada por fagos do grupo III. Abstract in english The presence of enterotoxic S. aureus in the nasal fossae of hospital food handlers was investigated. Material was collected from the anterior portion of fossae of 34 food handlers in the kitchens of three hospitals in the city of S. Paulo, Brazil. Of these 34 persons, 12 (35.3%) were positive for S. aureus, of these same 12, two (16.7%) showed positive for type C staphylococcal enterotoxin producing strains. Of the 12 strains isolated, nine (75%) could be phagetyped; of the enterotoxic strains, one was lysed by Group III phage; the other was non-typeable.
Thirty-one pairs of distal humeri were obtained from human cadavers ranging in age from fullterm neonates to fourteen years. These were studied morphologically and roentgenographically. Specimen roentgenography using air/cartilage interfacing demonstrated both osseous and cartilaginous components of the epiphyses. These roentgenographic aspects of development are discussed and illustrated to provide a basic reference index. The supracondylar region is characterized by a fossa which initially is in both metaphysis and epiphysis, but migrates to the metaphysis completely within the first year On either side of the fossa are osseous columns, which contrast with the broad metaphyseal bone above the columns. Within the fossa, anteriorly and posteriorly, are fat pads which may be elevated by intraarticular hematoma or reactive joint fluid. The physeal contour initially is transverse and smooth. Lappet formation progressively demarcates the epicondylar physeal regions, with the medial one becoming a functionally, but not histologically separate region. The capitellum is the first region to develop a secondary ossification center. This progressively expands into the trochlear portion of the epiphysis, a factor which predisposes to lateral condyle fracture propagation across the trochlear articular surface. The trochlea characteristically ossifies by multiple foci which fuse over time, often creating an irregular appearance to the developing ossification center. Epicondylar ossification tends to be from solitary foci. The lateral epicondylar center fuses with the capitellar center, whereas the medial epicondyle tends to be a functionally separate entity throughout development and does not normally fuse to the trochlear ossification center.
There are several studies addressing regression of residual nasopharyngeal angiofibroma after surgery, but spontaneous regression of this tumor has been reported in only 2 cases. We present a case of nasopharyngeal angiofibroma that has involuted spontaneously in the last 5 years. The tumor had been diagnosed at another institute. Computed tomography taken in 2002 had revealed the tumor occupying the entire sphenoid sinus and the pterygopalatine fossa, extending to the cavernous sinus and the infratemporal fossa on the right side. The vascularization of the tumor had been mainly from the internal maxillary artery on angiography. The internal maxillary artery had been occluded with a coil, but branches of internal carotid artery could not be embolized due to high risks of complications. In 2004 the patient was seen at our institute, and this time, repeated angiography revealed rich vascularization from the internal carotid artery. The patient did not accept any treatment and was put on follow-up. He had no complaint in January 2007. The tumor was seen to disappear completely, except a little remnant at the right pterygopalatine fossa on computed tomography. This is the third reported case in the literature with spontaneous regression of nasopharyngeal angiofibroma. PMID:19098582
We addressed the brain drainage system as inferred by the endocranial morphology of the occipito-temporal region of the El Sidrón Neandertal specimen SD-1219. Morphological details of the endocranial surface and its anatomical implications were analyzed for the reconstruction of the dural sinus drainage pattern and its comparison with Neandertals and other hominids. The specimen SD-1219 shows a pattern in which the superior sagittal sinus goes into the right transverse sinus. Comparative analyses with a large sample of fossil hominids reveal a pattern of the SD-1219 fossil that is typical for Neandertals. The analysis of the proportions of the occipital lobes prints within the occipital fossae reveals that the left occipital pole projects toward the right. This possibly indicates brain asymmetry (petalia) in this Neandertal individual, similar to that observed in some modern human brains. Conversely, no such asymmetry was observed in the cerebellar fossae. A particular feature of this fossil is the presence of two crests, located at the middle of the left cerebellar fossa that can be related to either an imprinting of a cerebellar fissure or some bone response to mechanical influence on internal bone surface morphology during cerebellar development. Specific aspects of the paleoneurology of Neandertals are discussed. Further quantitative studies on the endocranial morphology of the occipito-temporal and -mastoid region will shed light on the paleoneurological significance of this important anatomical region for the understanding of human evolution. PMID:18383277
Intracardiac echocardiography (ICE) serves as an adjunct to fluoroscopy for electrophysiological procedures by identifying critical anatomic landmarks and confirming catheter-endocardial contact. In the present study, we investigated the usefulness of ICE for radiofrequency catheter ablation. ICE was utilized to guide transseptal puncture in 19 patients undergoing radiofrequency catheter ablation. The fossa ovalis, which was one critical anatomic landmark, had an average vertical diameter of 18.5 ± 6.9 mm and an average horizontal diameter of 10.0 ± 2.4 mm, as measured by ICE and fluoroscopy. Although there was only a small shift of the puncture site in the horizontal direction, the puncture site shifted towards the upper edge of the fossa ovalis for 17 patients (89%). Furthermore, we could verify that the distance between the apex of the tent-shape formed by the pressure of the puncture needle in the fossa ovalis and the left atrial wall opposing it was sufficient to carry out the procedure safely. Confirming the puncture site using ICE is useful in carrying out transseptal left heart catheterization safely.
This study aims to evaluate the existence of anatomic abnormalities in the skull base that could contribute to the origin of primary spontaneous cerebrospinal fluid leaks (PSL). Twenty PSL patients were compared with 20 healthy individuals. The following features were measured through an analysis of computed tomography scans: the angles of the petrosal bones and skull base in both the sagittal and coronal planes; the anteroposterior and mediolateral diameters of the anterior skull base, sella, and sphenoid sinus; the depth of the olfactory fossa; the pneumatization of the sphenoid sinus; the position of the crista galli; and the state of the dorsum sellae. Body mass index (BMI) was compared. There were no differences between the two groups with respect to the angles and diameters of the anterior cranial fossa and the sphenoid sinus or the depth of the olfactory fossa. Pneumatization of the lateral recess of the sphenoid sinus was more frequent in the PSL group (55%) than in the control group (25%, p = 0.053). The dorsum sellae were eroded in 30% of the PSL patients but intact in all healthy subjects. PSL subjects showed higher sellae (1.0 versus 0.8 cm, p = 0.002). The average BMI of PSL patients was higher than that of the control group. Global alterations in the skull base of PSL patients were not found. The increase in the height of sellae and the erosion of its dorsum suggest intracranial hypertension. The higher BMI in the case group confirms the relation between obesity and PSL. (orig.)
Abstract in portuguese Relatamos nossa experiência com 11 pacientes portadores de meningiomas do forame magno, oito cranioespinhais e três espinocraniais. A média de idade foi 50,8 anos, o sintoma mais comum foi cefaléia occipital com duração média de 18,6 meses. Os principais achados neurológicos foram tetraparesia e comprometimento dos nervos cranianos baixos. O tratamento foi cirúrgico, sempre com exposição da artéria vertebral em sua entrada na dura-máter da fossa posterior e r (more) essecção de parte do côndilo occipital apenas em três casos. Ressecção total foi possível em sete pacientes e parcial nos demais, devido às aderências a vasos e nervos. O prognóstico esteve relacionado com as condições neurológicas pré-operatórias. Abstract in english We report our experience with 11 cases of foramen magnum meningiomas, eight originating inside the posterior fossa and three in the caudal region. The mean age of the patients was 50.8 years and the main complaint was cervical headache for at least 18.6 months and at the neurological examination, tetraparesis and deficit of the lower cranial nerves were very often observed. All patients were submitted to surgical treatment, always with exposition of the vertebral artery a (more) t the entry zone in the duramater of the posterior fossa, with partial removal of the occipital condyle in only three cases. Total resection was obtained in seven patients and partial removal in the other four due to adherences to vessels and nerves. The prognostic was related to the neurological condition before surgery.
Twelve patients (10 men, 2 women) with anterior cranial fossa dural arteriovenous fistula (AVF) were treated at our institute between January 1976 and March 2002. Intracranial hemorrhage was the presenting symptom in six patients. Magnetic resonance (MR) imaging findings identified abnormal cortical veins as flow voids in four of five patients. Angiography was the basis of the diagnosis in all patients. Surgery was the primary treatment in nine patients. The other three patients refused intervention and managed conservatively. Surgical morbidity was negligible and the treatment outcome was highly dependent on the clinical status at presentation. In contrast to the reported high incidence of intracranial hemorrhage in patients with dural AVF in the anterior cranial fossa, only half of our study population presented with hemorrhage. Enlarged cortical veins in the frontobasal area could be detected as flow voids on MR images. This finding contributed to the early diagnosis and treatment of patients treated at our institution for dural AVF in the anterior cranial fossa, and to the better outcomes we obtained in these patients.
Abstract in portuguese No presente trabalho, foram analisadas as complicações pós-operatórias observadas em 139 casos de impressão basilar e/ou malformação de Arnold-Chiari. Os autores chamam a atenção para a menor ocorrência de complicações e de mortalidade verificadas nos pacientes que foram submetidos à plástica da dura-mater da fossa posterior. Abstract in english The many kinds of complication that have been observed following operations of basilar impression and/or malformation of Arnold-Chiari are analysed. Two surgical techniques were adopted in the treatment of the patients. In the first 64 cases, the operation consisted in the craniectomy of the posterior fossa and high cervical laminectomy, while the dura-mater remained opened and suturated to the lateral musculature. Concerning the other 75 cases, it was made a plastic of t (more) he dura-mater of the posterior fossa and, in most of the cases, the patients were intubated with no retroflexion of the head and operated in sitting position without anterior flexion of the head. In the second group of patients, it was observed lesser occurrence of complications and death.
Aim: Posterior fossa strokes account for about 10% of ischaemic strokes in children. Although motor and dysautonomic symptoms are common, to our knowledge cognitive and affective deficits have not been described in the paediatric literature. Our aim, therefore, was to describe these symptoms and deficits. Method: In a retrospective study, we included all cases of posterior fossa strokes in children occurring at a single centre between 2005 and 2007, and investigated cognitive and affective deficits. Results: Five males aged 3 to 14 years met the inclusion criteria. They all presented very early with mood disturbances: outbursts of laughter and/or crying and alternating agitation or prostration that disappeared spontaneously within a few days. Persistent cognitive deficits were also diagnosed in all five: initial mutism, then anomia, followed by comprehension deficiency and deficiencies of planning ability, visual-spatial organization, and attention. Despite early and intensive rehabilitation, recovery from these cognitive deficits was slow and sometimes incomplete, and on follow-up they proved to be more disabling than the motor symptoms. Interpretation: These findings are similar to the cerebellar cognitive affective syndrome described in adults, and quite similar to the language and affective deficits observed in children after surgery for posterior fossa tumour. This is consistent with the role of the cerebellum and brainstem in affective and cognitive processes from early development.
Nine patients with medulloblastoma were referred to the Radiation Oncology Section at the University of Chicago from 1966 to 1976. In all patients, the tumor was situated in the posterior cranial fossa, projecting from the cerebellum into the fourth ventricle. After partial tumor resection and histological diagnosis, radiation treatment was instituted: a localized dose of 1000 rad to the posterior fossa through lateral opposing ports and a total dose of 4000 to 5000 rad through the hockey-stick port to the entire CNS. With this treatment, 9 patients yielded actuarial 3- and 5-year survival rates of 88% and 73%, respectively. Five of the patients possessed no history of neurologic or spinal growth deficits after treatment. Two patients had a slight retardation of spinal growth. The remaining patients had presented symptoms of a tumor mass in the posterior fossa for a period of over 8 months prior to treatment. They were found at craniectomy to have diffuse intracranial tumor involvement, and their survival times deteriorated rapidly. The hockey-stick port provided a uniform distribution of radiation exposure to the entire brain and spine. It was simple to use and posed little inconvience to patients in the pediatric age group.
Background. Surveillance imaging of the brain and spinal neuraxis in patients with posterior fossa malignant tumors is commonly performed, with the assumption that early detection of tumor recurrence will improve outcome. However, the benefit of this imaging has not been proven. To evaluate the usefulness of spinal surveillance imaging in children with nonmetastatic (at diagnosis, M0) posterior fossa ependymoma and medulloblastoma. Materials and methods. This retrospective study included 65 children (3 months to 16 years, mean 5.7 years) treated between 1985 and 1997 for ependymoma (22) and medulloblastoma (43). Medical records were reviewed for pathology and treatment data. Serial imaging of the head and spine was reviewed for evidence of tumor recurrence. Results. Twenty-four patients (37 %) had tumor recurrence, including 13 with ependymoma and 11 with medulloblastoma. Of the 17/24 recurrent patients initially diagnosed as M0 (6 medulloblastoma and 11 ependymoma), 13 (76 %) had a cranial recurrence only, and 4 (24 %) presented with concomitant cranial and spinal recurrence. No M0 patient presented solely with spinal metastases at recurrence. Conclusion. This study suggests that spinal surveillance imaging in patients with posterior fossa ependymoma or medulloblastoma initially staged as M0 may not be useful, as these patients initially recur intracranially. Thus, until an intracranial recurrence is detected, these patients may be spared the time, expense and sedation risk necessary for spinal imaging. (orig.)
To compare the diagnostic values of fluid-attenuated inversion recovery (FLAIR) and gradient spin-echo (GRASE) with those of conventional spin-echo (SE) and fast SE T2-weighted sequences in the evaluation of acute cerebrovascular lesions at 0.5 T. Material and Methods: Twenty-two consecutive patients with the clinical diagnosis of acute cerebrovascular accident were examined by MR imaging within the first 48 h of ictus. MR examination included 5-mm axial conventional SE and turbo SE (TSE) T2-weighted, dual-echo GRASE and FLAIR sequences. The patients also had pre- and postcontrast T1-weighted axial images. Two examiners evaluated the images and scored the conspicuity of the acute lesions. Results: Regardless of location, FLAIR provided the best lesion conspicuity in the detection of acute infarcts, followed by the GRASE sequence. In the posterior fossa, TSE and SE demonstrated the lesions better than GRASE and FLAIR techniques. In the detection of hemorrhagic elements within the ischemic region, TSE demonstrated statistically significant superiority over other sequences. Conclusion: In the detection of acute ischemic lesions in locations other than the posterior fossa, FLAIR provided the best lesion conspicuity among four T2-weighted sequences, including SE, TSE, GRASE and FLAIR. However, for the posterior fossa examination, preference of SE or TSE T2-weighted sequences is suggested.
Dengue viremia may be the trigger for immune complex formation in patients who are predisposed to developing autoimmune disease. We report a rare case of dengue virus infection evolving into systemic lupus erythematosus (SLE) and lupus nephritis. To the best of our knowledge this is the first case of dengue fever evolving into lupus nephritis. A 22 year old female presented with having had high grade fever, skin rash, breathlessness, retro-orbital pain, abdominal pain, arthralgias and myalgias for 10 days. She tested positive for dengue immunoglobulin M (IgM). She was given supportive treatment and was subsequently discharged. Four weeks later she developed recurrent fever, arthralgia, rash and anasarca. She was suspected as having SLE with active lupus nephritis. Antinuclear antibody (ANA), and anti double stranded deoxyribonucleic acid (anti dsDNA) titers were positive and complements were low. Renal biopsy showed diffuse proliferative glomerulonephritis grade IV. She was treated with steroids and immunosuppressants to which she responded. Dengue viremia incites antibody production, which if excessive causes deposition of viral antigen-antibody immune complexes. This could possibly lead to renal tubular damage and glomerulonephritis in susceptible individuals. Dengue fever leading to development of glomerulonephritis is rarely seen. Our patient developed dengue fever and after a month presented with manifestations of SLE and lupus nephritis. Both dengue fever and SLE have common manifestations of fever, arthralgia, rash, leucopenia with thrombocytopenia and serositis. Bacterial and viral infections may act as a 'trigger' for starting or relapsing lupus activity in genetically predetermined individuals. In our case it may be possible that dengue virus could have triggered a dysfunctional immune response, resulting in the developing of autoimmunity and SLE with lupus nephritis. PMID:22354536
Like the other herpesviruses, human herpesvirus (HHV)-6 is capable of persisting in the host after primary infection and can reactivate under immunosuppressed conditions. In stem cell transplantation recipients, HHV-6 reactivation is observed in 40-50% of patients and is linked to various clinical manifestations, including rash, delayed platelet engraftment and encephalopathy. HHV-6 reactivation is also relatively common in solid organ transplantation recipients, and is associated with graft dysfunction and subsequent development of human cytomegalovirus disease. In particular, HHV-6 has been recognized as a life-threatening pathogen for the development of encephalopathy after stem cell transplantation. Ganciclovir, foscarnet and cidofovir are effective against HHV-6 in vitro. However, suc...
Treatment for a 51-year-old man with pulmonary tuberculosis was initiated with isoniazid, rifampicin, ethambutol, and pyrazinamide, and discontinued after 3 weeks because of skin rash and itchiness. Isoniazid monotherapy was restarted after 2 weeks. Two days later, the platelet count decreased from 150 to 4×103/mm3. Despite platelet transfusion and oral corticosteroid treatment, the platelet count did not recover. However, after a 2-day administration of intravenous immunoglobulin, the platelet count recovered to 209×103/mm3. This report describes a case of isoniazid-induced thrombocytopenia that was reversed with intravenous immunoglobulin, thus highlighting the efficacy of this treatment for this rare condition.
A 10-year-old girl was admitted with fever, cough, maculopapular rash, hemoptysis, dark-colored urine, edema, multiple lymphadenopathies, and hepatosplenomegaly. She developed acute glomerulonephritis during the course of these complex clinical features. Laboratory data showed hematuria, proteinuria, and hypocomplementemia. Serological tests showed positive human parvovirus B19 (HPVB19)-specific immunoglobin M (IgM) and HPVB19 DNA was detected in the patient's serum using polymerase chain reaction (PCR). Renal biopsy revealed acute endocapillary proliferative glomerulonephritis (AEPGN) with coarse granular C3 depositions in a "starry sky pattern," which is more peculiar to poststreptococcal glomerulonephritis. Electron microscopy showed subendothelial and small hump-shaped subepithelial el...
Three patients with immune-mediated polyneuropathies developed rash, eczema, whole body scaling, vesicles in hands and loss of hair a few days after infusion of large doses of intravenous immunoglobulin (IVIG). The condition was diagnosed as exfoliative dermatitis. Two out of three patients were afterwards treated with low doses of IVIG slowly increased over a year given under the protection of oral steroids. Our findings indicate that exfoliative dermatitis can be provoked by IVIG treatment, and that the treatment can be reinstalled by slowly increasing the IVIG dose under steroid cover.
Please cite this paper as: Lamont R, Sobel J, Carrington D, Mazaki-Tovi S, Kusanovic J, Vaisbuch E, Romero R. Varicella-zoster virus (chickenpox) infection in pregnancy. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.02983.x. Congenital varicella syndrome, maternal varicella-zoster virus pneumonia and neonatal varicella infection are associated with serious fetomaternal morbidity and, not infrequently, mortality. Vaccination against varicella-zoster virus can prevent the disease, and outbreak control limits the exposure of pregnant women to the infectious agent. Maternal varicella-zoster immunoglobulin administration before rash development, with or without antiviral medication, can modify the progression of the disease.
Cetuximab is an epidermal growth factor receptor inhibitor used in metastatic colorectal cancer, and head and neck cancers. Several cutaneous side effects due to cetuximab such as acne-like rash, pruritus, dry skin, desquamation, hypertrichosis, and paronychia have been reported so far. A 59-year-old male patient with metastatic colon cancer referred to our outpatient clinic for his lesions on the dorsal surfaces of his hands and wrists, and on thighs developing after the chemotherapy. He was diagnosed as neutrophilic eccrine hydradenitis related to cetuximab in the light of clinical and histopathological findings. According to our knowledge, this is the first reported case of neutrophilic ecrine hydradenitis due to cetuximab.
Ethylmalonic encephalopathy (EE) is a rare autosomal recessive disorder caused by mutations in the ETHE1 gene and characterized by chronic diarrhea, encephalopathy, relapsing petechiae and acrocyanosis. Nephrotic syndrome has been described in an infant with EE but the renal histology findings were not described in previous reports. We report a Palestinian girl with EE who presented with chronic diarrhea, encephalopathy, petechial rash and acrocyanosis. Subsequently, she developed progressive deterioration of renal function caused by rapidly progressive glomerulonephritis resulting in death within few days. This is, to our knowledge, the first reported occurrence of rapidly progressive glomerulonephritis in a child with ethylmalonic encephalopathy. Its presence is a serious complication as...
Kounis syndrome has been known as allergenic angina and/or allergenic myocardial infarction following an allergic reaction. Probable allergic insults usually include drugs, latex, and food. Although ceftriaxone administration has been associated with various allergic reactions such as urticaria, angioedema, erythema, rash and anaphylactic shock, as far as we know, there is no published report that has shown an association between ceftriaxone use and Kounis syndrome. Here, we describe the first report of allergic vasospasm, culminating in acute inferior myocardial infarction, probably as the result of an acute allergenic reaction, after ceftriaxone use.
A site-specific surveillance project was conducted at the Koppers Company, a National Priorities List site. The findings indicated that living in the Koppers area was associated with a higher prevalance of reported rashes than among residents of a similar neighborhood in Texarkana not located near this site. Koppers residents did not appear to have higher rates of either adverse pregnancy outcomes or cancer than comparison residents. They did have many more concerns about their soil, water, and chemical odors in their neighborhood than did residents of the comparison neighborhood.
Vector repellent is one element in the prevention of vector-borne diseases. Families that neglect protecting their children against vectors risk their children contracting illnesses such as West Nile virus, eastern equine encephalitis, Lyme disease, malaria, dengue hemorrhagic fever, yellow fever, babesiosis, Crimean-Congo hemorrhagic fever, Rocky Mountain spotted fever, Southern tick-associated rash illness, ehrlichiosis, tick-borne relapsing fever, tularemia, and other insect and arthropod related diseases (CDC, 2011). Identification of families at risk includes screening of the underlying basis for reluctance to apply insect repellent. Nurses and physicians can participate in a positive role by assisting families to determine the proper prophylaxis by recommending insect repellent choic...
Infectious mononucleosis (IM) is a clinical syndrome most often attributable to Epstein-Barr virus (EBV). Characteristic clinical features of EBV IM include bilateral upper lid edema, exudative or nonexudative pharyngitis, bilateral posterior cervical adenopathy, and splenomegaly +- maculopapular rash. Laboratory features of EBV IM include atypical lymphocytes and elevated levels of serum transaminases. Leukopenia and thrombocytopenia are not uncommon. The syndrome of IM may also be attributable to other infectious diseases, eg, cytomegalovirus (CMV), human herpes virus-6 (HHV-6), or Toxoplasma gondii. Less commonly, viral hepatitis, leptospirosis, brucellosis, or parvovirus B19 may present as an IM-like infection. To the best of our knowledge, only 2 cases of IM-like infections attributab...
BackgroundIn general, viral infections of the central nervous system (CNS) manifest as encephalitis and, less commonly, as meningoencephalitis or aseptic meningitis. Varicella zoster virus (VZV) is an uncommon cause of encephalitis. MethodsHerpes zoster (shingles) is a cutaneous reactivation of previous chickenpox infection due to VZV. Herpes zoster may be dermatomal (ie, 3 dermatomes). Decreased cell-mediated immunity from stress, steroids, or immunosuppressive drugs often precede dermatomal/disseminated herpes zoster. With herpes zoster, the closer the dermatomal involvement is to the CNS (ie, head/neck shingles), the more likely a patient will have symptomatic CNS involvement (eg, encephalitis). Except for the association of the herpes zoster rash an...
Chenopodium album L. ssp. album is a common plant species worldwide, especially in humid areas. Sun exposure after oral intake of the plant can lead to sunburn-like rashes owing to its furocoumarin content. In this article, we reported nine patients who developed dermatitis with edema, erythema and necrosis on the face and dorsum of the hands. Each was exposed to sunlight after eating selemez (the vernacular name of C. album L. ssp. album). The plant samples analyzed by an expert botanist were described as C. album L. ssp. album belonging to Chenopodiacea family. PMID:22241627
Carbamazepine (CBZ) is frequently used for epilepsy and various psychiatric illnesses. It is known for its dermatological side effects which may range from mild rash to life-threatening reactions as Stevens Johnson syndrome or toxic epidermal necrolysis. We hereby report a rare case of 17-year-old woman suffering from generalized tonic clonic epilepsy with comorbid bipolar affective disorder, who was initially treated with sodium valproate with partial improvement. After 19 days of addition of CBZ to the therapy, the patient developed erythema multiforme major with >60% skin involvement and oral, conjunctival, intestinal, and vaginal mucosal involvement. PMID:21293372
Dengue fever, one of the common endemic viral fevers, often presents with fever, rash, and mild liver dysfunction. However, plasma leakage induced by dengue virus infection can lead to dengue hemorrhagic fever and dengue shock syndrome, and it can cause severe complications including liver failure and encephalopathy. Infection of dengue virus with other pathogens is an unusual but serious complication. We report a case of dengue shock syndrome with liver failure and impaired consciousness. The patient developed a disseminated Candida tropicalis infection, which may have been due to translocation of the fungus from the intestine damaged by the dengue virus.
Adverse health effects from exposure to N,N-diethyl-m-toluamide (DEET), and insect repellant, in employees of Everglades National Park, Florida were investigated in response to a request from the National Park Service. Neurobehavioral analysis showed significant correlations between DEET exposure and affective symptoms, insomnia, muscle cramps, and urinary hesitation. The authors conclude that skin rashes, daytime sleepiness, and impaired cognitive function are significantly associated with DEET exposure. Since a safe alternative is not available, it is recommended that exposure be minimized by using lower concentrations and making use of protective clothing.
We describe a patient who developed fever, fatigue, muscle weakness, dyspnea, skin rash, and eosinophilia after taking high doses of tryptophan for insomnia for two years. A gallium-67 scan revealed diffuse increased uptake in the lung and no abnormal uptake in the muscular distribution. Bronchoscopy and biopsy confirmed inflammatory reactions with infiltration by eosinophils, mast cells, and lymphocytes. CT scan showed an interstitial alveolar pattern without fibrosis. EMG demonstrated diffuse myopathy. Muscle biopsy from the right thigh showed an inflammatory myositis with eosinophilic and lymphocytic infiltrations.
The objective of this study is to evaluate the clinical features and prognosis of adult-onset Still's disease (AOSD). One hundred and four AOSD patients who were analyzed retrospectively were enrolled in this study. Medical charts were systematically reviewed for: demographic data, clinical features, laboratory findings, treatments, and outcomes. The major clinical features were: spiking fever 100%, evanescent maculopapular rash 95%, polyarthralgia 90%, sore throat 78%, lymphadenopathy 66%, hepatosplenomegaly 57%, hydrohymenitis 30%, neutrophilia 98%, liver disfunction 62%, increased erythrocyte sedimentation rate (ESR) 96%, and hyperferritinaemia 99%. Reactive hyperplasia was shown in all patients who underwent lymph node biopsy. Ninety-five percent and 63% of the patients were treated wi...
Background: Vancomycin has reliable antibacterial activity against many gram-positive pathogens but is associated with many adverse events. Teicoplanin, another glycopeptide, is associated with fewer adverse events, but its use in patients with previous vancomycininduced adverse reactions remains controversial. Objectives: The aims of this work were to evaluate the clinical characteristics of hospitalized patients with vancomycin-induced fever (ie, drug fever), rash, or neutropenia and to examine the tolerability of teicoplanin in these patients. Methods: This was a retrospective review of the medical charts of patients aged >=18 years who were hospitalized between January 2002 and October 2007 at National Cheng Kung University Hospital in Tainan, Taiwan. Patients were included if they exp...
Abstract: Biogenic amines have been reported in a variety of foods, such as fish, meat, cheese, vegetables, and wines. They are described as low molecular weight organic bases with aliphatic, aromatic, and heterocyclic structures. The most common biogenic amines found in foods are histamine, tyramine, cadaverine, 2 phenylethylamine, spermine, spermidine, putrescine, tryptamine, and agmatine. In addition octopamine and dopamine have been found in meat and meat products and fish. The formation of biogenic amines in food by the microbial decarboxylation of amino acids can result in consumers suffering allergic reactions, characterized by difficulty in breathing, itching, rash, vomiting, fever, and hypertension. Traditionally, biogenic amine formation in food has been prevented, primarily by l...
We reported one case of penile angiosarcoma in a 49-year-old patient who had been misdiagnosed as syphilis. Based on our experience, we suggest that if sexually transmitted diseases and Peyronie?s disease can be ruled out, diagnosis of the penile angiosarcoma be warranted if unexplained rash, ulceration on the penis, and induration in corpus cavernosum are observed. It should be noted that if the anti-inflammatory or anti-viral treatment is prescribed for some time but the lesion does not disappear or even gets worse, the penile angiosarcoma should be suspected and penile biopsy is necessary.
Summary Juvenile dermatomyositis, the most common inflammatory myopathy of childhood, is a rare systemic autoimmune vasculopathy that is characterised by weakness in proximal muscles and pathognomonic skin rashes. The length of time before the initiation of treatment affects presenting symptoms, laboratory measures, and pathophysiology. It also affects disease outcomes, including the development of pathological calcifications, which are associated with increased morbidity. Both genetic and environmental risk factors seem to have a role in the cause of juvenile dermatomyositis; HLA B8-DRB1*0301 ancestral haplotype is a strong immunogenetic risk factor, and antecedent infections and birth seasonality suggest that environmental stimuli might increase risk. Activation of dendritic cells with u...
A 30-year-old woman developed epidermolysis bullosa acquisita (EBA) with unusual clinical features. Initially, only prurigo-like nodules were seen, which lasted for > 2 years and then blisters appeared. Eruptions resembling the rash in systemic lupus erythematosus were also seen on the face. Histopathological examination of a biopsy specimen revealed subepidermal blisters containing eosinophils and neutrophils. Direct immunofluorescence examination, indirect immunofluorescence examination using skin split with 1 mol/L sodium chloride, and immunoblotting analysis using extracts of normal human dermis gave results compatible with EBA. This case shows that EBA can present with nodular lesions as seen in pemphigoid nodularis or epidermolysis bullosa pruriginosa. PMID:19817767
A case of autoimmune progesterone dermatitis is reported. The patient developed a recurrent eruption, primarily on the extremities, after receiving oral progesterone for the treatment of persistent amenorrhoea. Intradermal injection of 17 alpha-hydroxyprogesterone produced a positive skin reaction after 30 min, but no delayed onset reaction was observed. A patch test with progesterone in petrolatum was negative. The lymphocyte transformation test was normal. Histamine release from passively sensitized peripheral blood leukocytes was increased by progesterone preincubated in normal serum as a stimulating antigen. Conjugated oestrogen therapy suppressed the rash. Cyclical eruptions with elevated basal body temperature persisted for more than 20 months without menstruation. PMID:3158328
A 23yearold woman with prolonged fever, rash, and pericarditis associated with high titers of antinuclear, antiSm, and antiRNP antibodies was suspected of having systemic lupus erythematosus (SLE). However, we also considered infectious diseases, particularly Q fever, as the Creactive protein level was elevated and the patient reported contact with zoo animals around two weeks before the onset. The condition responded rapidly to administration of minocycline; symptoms resolved without using steroids. Thereafter, no recurrence of the illness was observed. Titer of Coxiella burnetii antibody was high and the illness was accordingly diagnosed as acute Q fever rather than SLE.
We report a case of meningococcemia without meningitis, which is a rare infectious disease in Japan. A 32-year-old woman was referred to our hospital with fever and joint pain. Her clinical presentation and the results of laboratory examination on admission suggested viral infection. However, her condition rapidly progressed to septic shock with fulminans purpura. Blood culture grew Neisseria meningitidis. She received antimicrobial therapy and underwent localized therapy for skin lesions. Meningococcal infection should be considered in patients who have fever along with skin rash or petechiae even when there are no signs of meningitis. In this report, we also review case reports of meningococcemia without meningitis in Japan.
Azathioprine hypersensitivity is a clinical syndrome which may manifest from isolated fever and rash to multi-organ failure. This rare condition is usually self-limiting following the discontinuation of azathioprine. Therefore, it is important to maintain a high index of clinical suspicion for hypersensitivity reactions with azathioprine therapy. We report a case of azathioprine hypersensitivity in a 69-year-old woman who developed cardiogenic shock and Sweet's syndrome following the initiation of azathioprine for her underlying autoantibodies to neutrophil cytoplasmic antigens (ANCA) associated microscopic polyangiitis.
Abstract: Background: Acrodermatitis acidemica is a recently proposed term for the rash that is similar to acrodermatitis enteropathica, which is encountered in organic acidemias. However, acrodermatitis enteropathica-like eruption may be seen in metabolic disorders other than organic acidemias. Objective: The aim of this study was to evaluate the clinical features of acrodermatitis enteropathica-like eruption secondary to metabolic disorders. Methods: Clinical and demographic features of 12 patients with acrodermatitis enteropathica-like eruption were prospectively evaluated between 2004 and 2006 in this single-center study. Results: Among the 12 patients, underlying metabolic disorders included maple syrup urine disease (n = 5), methylmalonic acidemia (n = 3), phenylketonuria (n = 2), or...
ABSTRACT: Borate-containing compounds were formerly used as topical antiseptics and were components of many medicinal preparations including skin powders and ointments used for the treatment of burns and diaper rash. These compounds were also used as irrigants for body cavities, including the pleural, vaginal, and rectal cavities. These applications were subsequently discontinued by the medical community when the toxicity and potential lethality of borates were recognized. Although documented cases of borate poisoning are now rare, the chemical is still an active component commonly used in high concentrations in household disinfectants/cleaners, pesticides, and wood preservatives. While the majority of documented borate-related deaths have occurred in infants, the toddler population is cur...
Individuals with bulimia nervosa (BN) often report co-morbid symptoms of non suicidal self-injury (NSSI). This study examined the influence of (lack of) perseverance, (lack of) premeditation, sensation seeking, and negative urgency (the tendency to act rashly when experiencing negative affect) on these two behavior patterns. We hypothesized that negative urgency influences vulnerability to multiple maladaptive behavior patterns, thus influencing the co-occurrence of NSSI and BN symptoms. 489 young adult women completed baseline assessments, and 209 completed an eight month follow-up assessment. Structural equation modeling was used to examine the influence of four personality pathways to impulsive behavior simultaneously on both behaviors at baseline, and the incremental predictive utility...
Abstract Background- Mastocytoses represent a heterogeneous group of stem cell disorders marked by an abnormal hyperplasia and accumulation of mast cells in one or more tissues, including bone marrow, gastrointestinal tract, liver, spleen, lymph nodes and skin. Indolent systemic mastocytosis (ISM) is characterized by red-brownish and pruriginous maculopapular lesions, a bone marrow infiltration without functional impairment and an indolent clinical course with a good prognosis. In particular, the most common cutaneous symptoms are urticarial rash and mild-to-high pruritus. Objectives- This study analyses the clinical outcome of patients affected by ISM with prevalent pruriginous cutaneous symptoms and a scarce response to anti-histamines treated using narrowband ultraviolet B (NB-UVB) phot...
Mosquito-transmitted alphaviruses causing human rheumatic disease are globally distributed and include chikungunya virus, Ross River virus, Barmah Forest virus, Sindbis virus, o'nyong-nyong virus and Mayaro virus. These viruses cause endemic disease and, occasionally, large epidemics; for instance, the 2004?2011 chikungunya epidemic resulted in 1.4?6.5 million cases, with imported cases reported in nearly 40 countries. The disease is usually self-limiting and characterized by acute and chronic symmetrical peripheral polyarthralgia?polyarthritis, with acute disease usually including fever, myalgia and/or rash. Arthropathy can be debilitating, usually lasts weeks to months and can be protracted; although adequate attention to differential diagnoses is recommended. The latest chikungunya viru...
A 26-year-old woman was referred to our department due to fever and skin rash after having taken medication for a common cold. Physical examination revealed erythematous skin changes on her body associated with mucosal involvement in her eyes and oral cavity. Peripheral blood examination revealed leukopenia and thrombocytopenia. Liver function test showed hyperbilirubinemia. She was managed with high dose intravenous immunoglobulin (IVIG) at 1.0 gm/kg of body weight infused for 5 consecutive days. Although the patient's skin lesion improved dramatically with IVIG therapy, her hyperbilirubinemia aggravated progressively. Eighteen months after her presentation, liver cirrhosis was diagnosed by ultrasonography, laboratory and liver biopsy findings.
Abstract in english Cytomegalovirus (CMV) infection is a common opportunistic systemic infection in immunocompromised patients, but skin involvement is rare. Herein, we report a 10 year-old girl from consanguineous parents who was referred to our center because of disseminated maculopapular rash. She had history of upper and lower respiratory tract infections. In immunological studies, increased serum IgE level and decreased responses to tetanus and diphtheria were detected. Polymerase chain (more) reaction (PCR) examination of bronchoalveolar lavage and serum sample revealed the presence of CMV. Early diagnosis of cutaneous CMV and appropriate treatment are the key actions in management of patients with underlying immunodeficiencies to avoid further complications.
The antiplatelets drug ticlopidine is widely used in patients suffering from cardiomyopathies, coronary cardiopathies and thromboembolic pathologies. The potential and frequently seen side effects are diarrhoea, hematological dyscrasias and rashes. We describe a case in which the use of ticlopidine in the treatment and prophylaxis of transit ischemic attacks triggered the unusual and rare complication of toxic epidermal necrolysis (TEN). We will then go on to analyse the clinical-pathological aspects and therapies through the use of i.v. immunoglobulins at high dosages that led to a full recovery of the patient. PMID:22095182
Background Because of its side-effects, long-term administration of ticlopidine limits the use of the sirolimus-eluting stent (SES) in Japan. Methods and Results Side-effects of ticlopidine occurred in 41 (9.3%) of 440 patients who underwent SES implantation. The majority were liver dysfunction (4.5%) and rash (3.6%). One patient died from severe liver dysfunction. Neutropenia occurred in 3 patients (0.7%). It is remarkable that 28% of side-effects occurred >8 weeks after the initiation of ticlopidine. Conclusions Ticlopidine has a relative high rate of side-effects. Clopidogrel should be approved for prevention of stent thrombosis as soon as possible. (Circ J 2007; 71: 617 - 619)
Afhandlingen undersøger den amerikanske Westerns indflydelse på nutidens sydstatslitteratur, navnlig mandlige hvide sydstatsforfattere. Ved at tage udgangspunkt i den feministorienterede maskulinitetsteori, undersøger jeg hvorledes forfatterne tackler diverse former for maskulinitet, om de blot videregiver Westerngenrens monolitiske og hegemoniske verdenssyn, eller om der er tale om et nyt billede af amerikansk manddom. Afhandlingen bygger på seks primærtekster: Lewis Nordans The Sharpshooter Blues (1995), Larry Browns Father and Son (1996), Chris Offutts The Good Brother (1995), William Gays The Long Home (1999), Barry Hannahs Yonder Stands Your Orphan (2001) og Ron Rash: One Foot in Eden (2002).
Abstract Background Cetuximab is a chimeric human-murine monoclonal antibody against the epidermal growth factor receptor (EGFR). It has shown activities against multiple malignancies in clinical trials. EGFR-inhibitors (EGFRI) often cause skin toxicity, most frequently acneiform eruption. Xerosis, eczema, fissures, teleangiectases, nail changes and paronychia can be seen in some cases, rarely hyperpigmentation. Materials and methods We reviewed local practice of skin toxicity management during treatment with cetuximab. From November 2005 to January 2007, 31 patients with metastatic colorectal cancer were treated with cetuximab in combination with chemotherapy. They all suffered from acne-like rash. They were followed up for at least 3 months, once per week. Skin toxicity was evaluated acc...
Hyper IgE syndrome (HIES) is a rare primary immunodeficiency disorder, characterized by eczema, recurrent skin and lung infections, and significantly elevated serum IgE level. It was previously diagnosed based on clinical manifestations and laboratory markers that were not specific to the disease. Recent studies have demonstrated that mutations in signal transducer and activator of transcription 3 (STAT3) cause the autosomal dominant or sporadic HIES, which make the disease definitively characterized at molecular level. Here, we reported a 3-year old Chinese boy with neonatal-onset rash and multiple serious Staphylococcus aureus infections including recurrent skin abscesses, liver abscess, sepsis, and destructive pulmonary infection (pneumonia, multiple pulmonary abscesses, pyopneumothorax...
A 72-year-old woman presented with dyspnea and lower extremity edema. Extreme lymphocytosis, cytopenia, and splenomegaly were found, and she was diagnosed with B-prolymphocytic leukemia. Following the first dose of therapy with bendamustine, the patient developed severe generalized maculopapular rash, which subsequently progressed to exuberant, non-blanching palpable purpura with hemorrhagic plaques suspicious for leukocytoclastic vasculitis. These events coincided with severe chemotherapy-induced neutropenia and thrombocytopenia, but there were no clinical symptoms of infection. Skin punch biopsy revealed perivascular and diffuse upper dermal lymphocytic infiltrate with eosinophils and marked erythrocyte extravasation consistent with a purpuric drug exanthem. The patient was treated with ...
Object McLone and Knepper's unified theory of Chiari malformation Type II (CM-II) describes how the loss of CSF via the open posterior neuropore fails to create adequate distending pressure for the developing rhomboencephalic vesicle. The authors of the present article describe the relationship between the posterior fossa volume and intracranial cerebellar volume as being related to the distance from the obex of the fourth ventricle to the myelomeningocele lesion using a common mathematical model, the Hagen-Poiseuille law. Methods All newborns who required closure of a myelomeningocele at the authors' institution between 2008 and 2011 and who were between 4 weeks premature and 2 months, corrected gestational age, at the time of MRI were included in this study. Volumes and measurements were obtained from axial and sagittal T2-weighted MR images of the brain and spine. Results: A total of 56 newborn infants met the inclusion criteria. There was a direct linear relationship between both posterior fossa volume and cerebellar volume and the spinal level of the myelomeningocele lesion (p = 0.0012 and p = 0.0041, respectively). There was a negative linear relationship between the cerebellar descent, the spinal level of the lesion, and posterior fossa volume and cerebellar volume. These relationships strengthen in patients with no syringomyelia and are not significant in those groups with syringomyelia. The results of a 1-way ANOVA for the 3 groups did not reach significance. Conclusions Using a linear equation derived from the Hagen-Poiseuille law that describes pressure in the fourth ventricle as being directly related to the length of the central canal from the obex to the myelomeningocele lesion, the authors were able to explain the directly observed linear relation between posterior fossa volume, intracranial cerebellar volume, and cerebellar descent to the level of the spinal lesion. As this model assumes a uniform radius of the central canal they were able to validate this model when they observed a strengthening in relationships in the no syringomyelia group and statistically insignificant correlations in the groups with syringomyelia. They therefore propose that the spinal level of the lesion is one of the major determinants of posterior fossa volume, intracranial cerebellar volume, and cerebellar ectopia. PMID:23157392
Abstract in portuguese O conhecimento anátomo-cirúrgico da região zigomática é fundamental para o aprimoramento de técnicas anestésicas tronculares do nervo maxilar. A literatura pouco se refere à trajetória do nervo maxilar e seus ramos nessa região, portanto, o presente estudo tem como objetivo esclarecer o percurso desses nervos. Foram dissecadas ao microscópio cirúrgico MC900 (D.F.Vasconcelos), 30 hemicabeças humanas, de ambos os sexos, que foram previamente formolizadas a 10% (more) e desmineralizadas em ácido nítrico a 5%. Observou-se que o nervo maxilar, desde sua origem na fossa pterigopalatina até penetrar na fissura orbital inferior, emite de um a três ramos alveolares superiores posteriores e ramos tuberais descendentes que vão para estruturas moles da região. Os nervos alveolares superiores posteriores, descem adjacentes à tuberosidade da maxila, na qual penetram através dos canais alveolares junto com a artéria homônima e podem emitir filetes nervosos que continuam trajeto extra-ósseo. Contrariando os achados da literatura, com este estudo observou-se que o nervo maxilar apresenta praticamente dois terços de sua trajetória na região zigomática e o restante na fossa pterigopalatina. Abstract in english Anatomic knowledge on the zygomatic fossa is of primary importance to improve the regional anesthetic technique of the maxillary nerve. Few reports in the literature have addressed the trajectory of the maxillary nerve and its branches in this region; thus, this study aimed at presenting information about the trajectory of these nerves. Thirty human half-heads of both genders were fixed in 10% formalin and demineralized in 5% nitric acid, and the maxillary nerve was disse (more) cted since its origin on the pterygopalatine fossa until penetration into the inferior orbital fissure. It was observed that the maxillary nerve sends one to three posterior superior alveolar branches and tuberal descendent branches, which supply the soft tissue structures of the region. The posterior superior alveolar nerves are inferiorly oriented near the maxillary tuberosity, where they penetrate the alveolar canals with the posterior superior alveolar artery and send small nerve branches that continue in an extraosseous trajectory. This study found that nearly 2/3 of the trajectory of the maxillary nerve is located in the zygomatic region, with a short segment (1/3) in the pterygopalatine fossa.
Abstract in portuguese O crescente interesse de crianças e adolescentes por esportes competitivos induz a uma maior preocupação em prescrever treinamentos adequados a essa população específica. O conhecimento do impacto da intensidade de treinamento físico competitivo sobre a saúde de adolescentes são ainda incipientes na literatura científica. Este estudo objetivou investigar as respostas agudas do lactato sanguíneo (Lac) e da creatinofosfoquinase (CPK) após uma sessão de treiname (more) nto físico em atletas jovens treinados em diferentes modalidades esportivas. Participaram 43 adolescentes do sexo masculino entre 9 e 17 anos, distribuídos em três grupos: nadadores, tenistas, jogadores de futebol de salão. Os protocolos para cada modalidade seguiram o planejamento normal de uma sessão específica. A dieta no dia anterior à coleta foi padronizada e as 24 horas que precediam a avaliação foram dedicadas ao repouso dos atletas. Foram coletados 5ml de sangue da veia antecubital imediatamente antes da realização da sessão de treinamento, repetindo coleta idêntica, imediatamente após a sessão. Foi obtida a idade óssea para a avaliação da maturação esquelética pelo método de Greulich & Pyle. Análise de variância Kruskal-Wallis e teste U-de Mann-Whitney foram utilizados para comparações entre os grupos. Valores de p Abstract in english The growing interest of children and adolescents in competitive sports demands a higher concern with suitable training prescription to this specific population. The knowledge of the impact of the competitive physical training intensity over the young population's health is still scarce in the literature. Thus, the aim of this study was to examine acute responses in blood lactate (Lac) and creatine phosphokinase (CPK) concentration after a physical training session with yo (more) ung athletes trained in different sports modalities. Forty-three male adolescents (aged 9-17 years) were divided in three groups: swimmers, tennis players, and indoor soccer players. There were no changes in rules or procedures before or after the practice session. Diet and activity (no exercise) were standardized during the twenty-four hours before the evaluation. Venous blood samples (5 mL) were collected from the antecubital vein immediately before and after the training session. The bone age was obtained through the Greulich & Pyle method and was analyzed for skeleton maturity grading. Statistical analysis included Kruskal-Wallis variance analysis and Mann-Whitney U test (alpha was set at 0.05). Both Lac and CPK were higher post-session than pre-session in all sports studied. Age appeared to influence Lac and CPK concentration. The age group between nine and eleven years old had lower values compared to the older group, both pre- and post-session. The increases in CPK and Lac with exercise are similar to the findings previously reported in the literature. Moreover, CPK and Lac are higher with older chronological age. Thus, it is possible to demonstrate that Lac and CPK have a positive correlation to bone maturation and chronological age.
We measured uterine extraction (i.e. metabolism) and transuteroplacental interconversion of cortisol (F) and cortisone (E) to determine whether metabolism across the uterus changes during pregnancy and contributes to the MCR of these corticosteroids. On day 100 (n . 4) or 170 (n . 3) of pregnancy (term . day 184), baboons (Papio anubis; 14-18 kg) were sedated with ketamine, and a constant infusion (0.38 ml/min) of 8-12 microCi (/sup 3/H)F and 9-15 microCi (/sup 14/C)E in 80 ml 0.9% NaCl-1% ethanol was initiated (time zero) via a maternal antecubital vein. At 60 min, animals were laparotomized, and at 70, 80, and 90 min, blood samples were obtained from right and left uterine veins and from a maternal saphenous vein. At 95 min, a transverse incision was made in the uterus, the fetus was isolated, and blood samples were obtained from the umbilical vein and artery. The cord was then clamped, and the fetus was delivered. Radio-labeled F and E were extracted from serum and purified by sequential paper chromatography, and metabolic parameters were calculated. Endogenous F and E levels were determined by RIA. In the mother, the percent conversions of E to F at midgestation (mean +/- SE; 72 +/- 4) and late gestation (65 +/- 3) were similar and exceeded (P less than 0.01) respective values for oxidation of F to E (51 +/- 7 and 46 +/- 7, respectively), indicating that maternal corticosteroid metabolism favors F formation and is unchanged during the second half of gestation. In contrast, corticosteroid metabolism across the uterus and placenta (transuteroplacental) was altered during pregnancy. At midgestation, transuteroplacental conversion of E to F (37 +/- 9) exceeded (P less than 0.05) the reverse reaction (18 +/- 3), whereas oxidation of F to E at term (28 +/- 4) was 7-fold greater (P less than 0.05) than reduction of E to F (4 +/- 1).
Regeneration of pulp-dentin complex in an infected necrotic tooth with an open apex is possible if the canal is effectively disinfected. The purpose of this case report is to add a regenerative endodontic case to the existing literature about using Platelet Rich Fibrin (PRF). A nine year old boy who accidently broke his immature maxillary central incisor tooth, developed pulpal necrosis with apical periodontitis. After the access cavity preparation, the canal was effectively irrigated with 20 ml of 5.25% sodium hypochlorite solution and 10ml of 0.2% chlorhexidine solution and dried with paper points. Triple antibiotic paste was placed inside the canal and left for 21 days. 12 ml of whole blood was drawn from the patient's right antecubital vein and centrifuged for 10 minutes to obtain the Choukroun's PRF. After the removal of the triple antibiotic paste, the PRF was placed into the canal till the level of cementoenamel junction and 3mm of grey MTA was placed directly over the PRF clot. The setting of MTA was confirmed 3 days later and the tooth was double sealed with GIC and Composite restoration. After 1 year the clinical examination revealed negative responses to percussion and palpation tests. The tooth responded positively to cold and electric pulp tests. Radiographic examination revealed continued thickening of the dentinal walls, root lengthening, regression of the periapical lesion and apical closure. On the basis of the results obtained in our case report we conclude that revitalization of necrotic infected immature tooth is possible under conditions of total canal disinfection and PRF is an ideal biomaterial for pulp-dentin complex regeneration. PMID:23112492
Negative product value for coronary artery disease is 98% to 99%. Therefore, the number of unnecessary cardiac catheterization procedures is reduced as the usefulness of CT systems for examination of the coronary arteries improves. In the bolus-tracking method, in which an ROI is placed in the ascending aorta to trigger scanning, scanning may not be performed at the optimal time of contrast enhancement depending on the patient. In addition to identifying the causes of this problem, we have developed a new method in which ROIs are placed in the right ventricle and left atrium to trigger scanning when the concentrations of contrast medium in the right ventricle and left atrium become equal. The two methods were then compared and evaluated. In the scan method, in which an ROI is placed in the ascending aorta, the reason for non-optimal scan timing is considered to be that the time required for contrast medium injected via an antecubital vein to reach the heart varies depending on the individual patient(approximately 3 times the variation of our method)followed by a delay of approximately 5 seconds between the scan trigger time and the actual scan start time. In the scan method in which scanning is triggered when the concentrations of contrast medium in the right ventricle and left atrium become equal, scanning can be performed at the time of peak enhancement regardless of differences in the time required for the injected contrast medium to reach the target region or differences in the injection rate, demonstrating the usefulness of this method. PMID:17625356
This paper reports the findings of two investigations into methodological problems associated with the interpretation of blood lactate (BLa) in the sports sciences. In Experiment 1, brachial artery (A), antecubital venous (V) and fingertip capillary (C) blood samples were drawn simultaneously from nine subjects (mean age 21.1 +/- 1.3 years) during an incremental treadmill protocol and immediately assayed for BLa concentration. Experiment 2 investigated the extent of lactate concentration differences in whole blood (WB), lysed blood (LB) and plasma (P) measured using a YSI 23 AM analyser. In Experiment 1, a comparison of the mean BLa concentrations obtained from the three sites revealed no significant differences (P greater than 0.05). Correlations between BLa samples from different sites were very high, with r values ranging from 0.858 to 0.983. In Experiment 2, the mean lactate concentrations were: WB, 4.7 +/- 2.7 mM; LB, 5.0 +/- 3.0 mM; P, 7.0 +/- 3.8 mM. Plasma (P) values were significantly higher than WB and LB. Values from all sites were highly correlated with coefficients ranging from 0.963 to 0.987. In conclusion: (1) Significant arterial and venous BLa concentration differences do not exist during incremental treadmill exercise. (2) As capillary BLa concentrations reflect arterial values, their use in laboratory and field settings is recommended. (3) Lactate concentration differences in whole blood, lysed blood and plasma will influence the assessment of performance at fixed lactate reference values. (4) If the inter-laboratory test procedures are to be standardized and results compared, precise reporting of lactate sampling and assay techniques is critical. PMID:1588685
Background & objectives: Bone marrow mononuclear cell therapy has emerged as one of the option for the treatment of Stroke. Several preclinical studies have shown that the treatment with mononuclear cell (MNCs) can reduce the infarct size and improve the functional outcome. We evaluated the feasibility, safety and clinical outcome of administering bone marrow mononuclear cell (MNCs) intravenously to patients with subacute ischaemic stroke. Methods: In a non-randomized phase-I clinical study, 11 consecutive, eligible and consenting patients, aged 30-70 yr with ischaemic stroke involving anterior circulation within 7 to 30 days of onset of stroke were included. Bone marrow was aspirated from iliac crest and the harvested mononuclear cells were infused into antecubital vein. Outcomes measured for safety included immediate reactions after cell infusion and evidence of tumour formation at one year in whole body PET scan. Patients were followed at week 1, 4-6, 24 and 52 to determine clinical progress using National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), modified Rankin Scale (mRS), MRI, EEG and PET. Feasibility outcomes included target-dose feasibility. Favourable clinical outcome was defined as mRS score of 2 or less or BI score of 75 to 100 at six months after stem cell therapy. Results: Between September 2006 and April 2007, 11 patients were infused with bone-marrow mononuclear cells (mean 80 million with CD-34+ mean 0.92 million). Protocol was target-dose feasible in 9 patients (82%). FDG-PET scan at 24 and 52 wk in nine patients did not reveal evidence of tumour formation. Seven patients had favourable clinical outcome. Interpretation & conclusions: Intravenous bone marrow mononuclear cell therapy appears feasible and safe in patients with subacute ischaemic stroke. Further, a randomized controlled trial to examine its efficacy is being conducted. PMID:20445298
Abstract in portuguese Os autores relatam cinco acidentes de "seabather's eruption" ou prurido do traje de banho, uma erupção típica associada na maioria das vezes à água-viva Linuche unguiculata (Cnidaria), que causa um "rash" pápulo-eritematoso extremamente pruriginoso em áreas cobertas por trajes de banho. O quadro cutâneo é característico e a erupção é comum no Caribe, Flórida, México e estados americanos do Golfo. Os casos são os primeiros relatados no Brasil e larvas de Linuche unguiculata estão presentes nas águas onde ocorreram os acidentes. Abstract in english The authors report five cases of seabather's eruption, a typical dermatitis associated predominantly to the jellyfish Linuche unguiculata (Cnidaria), that causes erythematous and pruriginous papules on areas of the skin of bathers covered by swimsuits. The rash is characteristic and the eruption is commom in the Caribbean, Florida, Mexico and Gulf States of USA. The cases are the first reported in Brazil and larvae of the jellyfish are present in the waters where the accidents happened.
BackgroundCetuximab-induced hypomagnesemia has been associated with improved clinical outcomes in advanced colorectal cancer (CRC). We explored this relationship from a randomized clinical trial of cetuximab plus best supportive care (BSC) versus BSC alone in patients with pretreated advanced CRC.Patients and methodsDay 28 hypomagnesemia grade (0 versus ?1) and percent reduction (<20% versus ?20%) of Mg from baseline was correlated with outcome.ResultsThe median percentage Mg reduction at day 28 was 10% (-42.4% to 63.0%) for cetuximab (N = 260) versus 0% (-21.1% to 25%) for BSC (N = 251) [P < 0.0001]. Grade ?1 hypomagnesemia and ?20% reduction from baseline at day 28 were associated with worse overall survival (OS) [hazard ratio, HR 1.61 (95% CI 1.12-2.33), P = 0.01 and 2.08 (95% CI 1.32-3.29), P = 0.002, respectively] in multivariate analysis including grade of rash (0-1 versus 2+). Dyspnea (grade ?3) was more common in patients with ?20% versus < 20% Mg reduction (68% versus 45%; P = 0.02) and grade 3/4 anorexia were higher in patients with grade ?1 hypomagnesemia (81% versus 63%; P = 0.02).ConclusionsIn contrast to prior reports, cetuximab-induced hypomagnesemia was associated with poor OS, even after adjustment for grade of rash. PMID:23144444
Abstract in english Background: Adult Still's disease is an inflammatory disorder characterized by quotidian fevers, and an evanescent rash. Its presentation can be acute or subacute. Aim: To report our experience with Adult Still's disease. Material and methods: Systematic retrospective review of medical records of nine men and 11 women aged between 17 and 57 years, with Still's disease, followed in two public hospitals of Metropolitan Santiago. Results: Eighty percent of patients had a pri (more) or different diagnosis. All presented with fever and joint involvement. Eighty percent had malaise, 80% had odynophagia, 80% had an evanescent rash, 70% had myalgias, 50% had lymph node enlargement and 40% had splenomegaly. Laboratory showed ¡eukocytosis in 80% and a high erythrocyte sedimentation rate in all. High ferritin levels were detected in 80%, and became an important diagnosis clue. Initial treatment was based on non steroidal antiinflammatory drugs, however 80% required steroids and 35% required methotrexate. Azathioprine, sulphalazine, hydroxychloroquine and ¡eflunomide were used occasionally. Eleven patients had a single episode, nine had a relapsing disease and four had a chronic or persistent mode. Conclusions: Adult Still's disease must be suspected in patients with fever of unknown origin. An early diagnosis and adequate treatment of the disease are associated with a favorable evolution and prognosis.
A 94C>A missense mutation in the ITPA gene which encodes inosine triphosphate pyrophosphatase has been associated with adverse effects from azathioprine, specifically flu-like symptoms, pancreatitis and rash. We hypothesized that this association may also be present in a larger, population-based group of inflammatory bowel disease patients intolerant of thiopurine drugs. We performed genotyping for this polymorphism and TPMT*2 and TPMT*3 in 73 such patients and 74 patients with inflammatory bowel disease who have tolerated azathioprine. We could not demonstrate a significant association between the ITPA94C>A genotype and any adverse effects (Odds ratio (OR) 1.015, 95% confidence interval (CI) 0.360-2.867, P = 0.593), flu-like symptoms (OR 1.547, 95%CI 0.368-6.496, P = 0.398), rash (no ITPA 94C>A polymorphism identified) or pancreatitis (no ITPA 94C>A polymorphism identified). We found no significant association between the ITPA 94C>A polymorphism and adverse effects to thiopurine drugs. PMID:15564886
2,6-Dimethylaniline (DMA) is known as a major metabolite of xylazine, ?2-adrenergic agonist used as a tranquilizer for domestic animals, and has been reported to have a carcinogenic potential to the nasal cavity in rats as well as a nasal tumor pomoting effect in rats. In order to examine whether DMA has any tumor modifying effect in the other respiratory organs, transgenic mice carrying the human prototype c-Ha-ras gene (rasH2 mice) that are highly susceptible to genotoxic carcinogens were given diet containing 0 or 3000 ppm DMA for 26 weeks or 0 or 2000 ppm DMA for 53 weeks after initiation with 4-(Methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). Their non-transgenic CB6F1 littermates (non-Tg mice) were also treated in the same manner. No significant difference in the incidence/multiplicity of pulmonary proliferative lesions was observed between the groups treated with NNK alone and NNK plus DMA. These results suggest that DMA has no tumor modifying effect in pulmonary proliferative lesions induced in rasH2 and non-Tg mice.
Abstract in spanish Se presentó el caso de una niña de 10 años de edad con antecedentes de ingestión de carbamazepina por diagnóstico presuntivo de epilepsia, quien ingresó en el Hospital Provincial Pediátrico Docente Eliseo Noel Caamaño, en Matanzas, en mayo del 2010, por cuadro de fiebre, rash cutáneo y vómitos al inicio, con evolución severa y la aparición de ictericia, hepato-esplenomegalia. Se realizó diagnóstico de síndrome DRESS, con evolución satisfactoria sin el uso (more) de la terapia esteroidea. Se revisó la literatura sobre síndrome de hipersensibilidad por anticonvulsivantes, medicamentos de uso cada vez más frecuente. Abstract in english We presented the case of a 10-years-old girl with antecedents of carbamazepine ingestion for epilepsy presumptive diagnosis, who entered the Teaching Pediatric Provincial Hospital Eliseo Noel Caamaño, in Matanzas, in May 2010, with fever, skin rash and vomiting at the beginning, followed by severe evolution, with jaundice and hepato-splenomegaly. We diagnosed the DRESS syndrome, with satisfactory evolution without using the steroidal therapy. We reviewed the literature about the hypersensibility syndrome for anticonvulsants, drugs of more and more frequent use.
Abstract in portuguese Febre maculosa brasileira (FMB) é a mais importante e frequente doença rickettsial no Brasil. Relatamos um caso fatal de FMB em um homem negro de 32 anos de idade que morreu de choque irreversível após cinco dias de febre, cefaléia intensa, dor abdominal, e sem evidência de exantema. Amostras de baço, rim e coração coletadas na necropsia foram positivas para Rickettsia rickettsii por PCR e sequenciamento. Os autores ressaltam a necessidade de um alto índice de s (more) uspeita diagnóstica para febre maculosa em pacientes negros. Ausência de exantema não deve dissuadir os clínicos de considerar a possibilidade de FMB e iniciar a terapêutica empírica. Abstract in english Brazilian spotted fever (BSF) is the most important and frequent rickettsial disease in Brazil. A fatal case of BSF is reported in a 32-year-old black man, who died of irreversible shock after five days of fever, severe headache and abdominal pain with no rash. Spleen, kidney and heart samples collected at autopsy were positive for Rickettsia rickettsii by PCR and sequencing. The authors emphasize the need for a high index of diagnostic suspicion for spotted fever in blac (more) k patients. Absence of a skin rash should not dissuade clinicians from considering the possibility of BSF and initiating empirical therapy.
Abstract in spanish La fiebre manchada de las Montañas Rocosas (FMMR) es una enfermedad febril aguda causada por Rickettsia rickettsii, caracterizada por un exantema petequial. A pesar de conocer su etiología y manifestaciones clínicas y de disponer de un tratamiento eficaz, su letalidad aún es elevada. En sus estadios iniciales, la FMMR puede aparentar muchas otras enfermedades infecciosas y dificultar su diagnóstico. El presente trabajo informa dos casos con FMMR que ilustran la impor (more) tancia de su diagnóstico oportuno y tratamiento adecuado, así como de considerar a la FMMR como diagnóstico diferencial ante un paciente febril con exantema que resida en área endémica. Abstract in english Rocky Mountain spotted fever (RMSF) is an acute febrile illness caused by infection with Ricketsia Rickettsii, characterized by the presence of petechial rash. Even though the etiology, clinical characteristics and availability of effective antibiotics are known, RMSF related deaths have a prevalence of 4%. In its early stages RMFS can resemble many others infectious conditions and the diagnosis can be difficult. The present paper reports two patients with RMSF; these cas (more) es underscore the importance of prompt diagnosis and appropriate antimicrobial therapy, and consider RMSF as a differential diagnosis in any patient who develops fever and rash in an endemic area.
In order to examine tumor modifying effects of phenolphthalein (PhP), female transgenic mice carrying human prototype c-Ha-ras gene (rasH2 mice) were given a single intraperitoneal injection of 60 mg/kg body weight of N-ethyl-N-nitrosourea (ENU), followed by the diet containing 12,000 ppm PhP for 26-week. Histopathologically, alveolar hyperplasias, adenomas and adenocarcinomas were observed in the ENU + PhP group, but only hyperplasias and adenomas were observed in the ENU alone group. The incidence and multiplicity of adenocarcinomas in the ENU + PhP group was significantly increased as compared to that in the ENU alone group. The combined multiplicity of adenomas and adenocarcinomas in this group was also significantly higher than that of the ENU alone group. In addition, the ratio of area of adenomas in the ENU + PhP group was significantly higher than that in the ENU alone group. The result of our study suggests that PhP has a clear tumor promoting effect in the lung of rasH2 mice.
Background A retrospective, registry-based analysis to assess the outcomes of metastatic renal cell cancer (mRCC) patients treated with sunitinib and sorafenib who developed dermatologic adverse events was performed. Patients and Methods Data on mRCC patients treated with sunitinib or sorafenib were obtained from the Czech Clinical Registry of Renal Cell Cancer Patients. Outcomes of patients who developed hand-foot syndrome (HFS) of any grade and/or grade 3/4 rash during the treatment were compared with patients without HFS and no, mild, or moderate rash. Results The cohort included 705 patients treated with sunitinib and 365 patients treated with sorafenib. For sunitinib, the median overall survival (OS) was 43.0 months versus 31.0 months (P = 0.027) and median progression-free survival (PFS) 20.8 months versus 11.1 months (P = 0.007) for patients with versus without dermatologic toxicity, respectively. For sorafenib, the median OS and PFS were 27.9 and 24.6 months (P = 0.244), and 12.2 and 8.8 months (P = 0.050), respectively. In multivariable Cox regression, the skin toxicity was significantly associated with longer OS in the sunitinib cohort. Conclusion The presence of skin toxicity is associated with improved OS and PFS in patients with mRCC treated with sunitinib. PMID:22700990
In order to examine the modifying effects of co-administration of t-butylhydroquinone (TBHQ) and sodium nitrite (NaNO2) on forestomach carcinogenesis, a total of 50 male transgenic mice carrying a human prototype c-Ha-ras gene (rasH2 mice) received a single intraperitoneal injection of 60 mg/kg body weight of N-ethyl-N-nitrosourea (ENU), and starting 1 week later, they were given diet containing 0 (control group) or 0.5% TBHQ (TBHQ alone group), drinking water containing 0.2% NaNO2 (NaNO2 alone group) or diet containing 0.5% TBHQ in combination with 0.2% NaNO2 in drinking water (TBHQ+NaNO2 group) for 20 weeks. Squamous cell hyperplasias, papillomas and carcinomas were induced in all of the ENU treated groups, and there were no significant differences in the incidence, multiplicity and PCNA labeling index of these forestomach proliferative lesions between the NaNO2 alone, TBHQ alone, TBHQ+NaNO2 and control groups. These results suggest that the co-administration of TBHQ and NaNO2 does not cause any modifying effects on ENU-induced forestomach carcinogenesis in rasH2 mice.
DEFINITION: Late adverse reactions (LAR) to contrast media (CM) are defined as reactions occurring 1 h to 1 week after exposure. NEED FOR REVIEW: In view of more prospective studies of LAR and new data about their pathophysiology, the Contrast Medium Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) reviewed the literature on LAR and updated their guidelines. CLINICAL FEATURES AND PATHOLOGY: LAR after CM include symptoms such as nausea, vomiting, headache, itching, skin rash, musculoskeletal pain, and fever. Skin reactions are well-documented LAR to CM with an incidence of approximately 2%-4% after nonionic monomers. LAR are commoner by a factor of three to four after nonionic dimers. The commonest skin reactions are maculopapular rashes, erythema and skin swelling. These reactions are T cell-mediated immune reactions, and the diagnosis may be confirmed using skin tests (patch or delayed reading intradermal). The main risk factors for LAR are a previous reaction to contrast medium, a history of allergy, and interleukin-2 treatment. Most skin reactions are mild or moderate and self-limiting. MANAGEMENT: Management is symptomatic and similar to the management of other drug-induced skin reactions. To reduce the risk of repeat reactions avoidance of the relevant CM and any cross-reacting agents identified by skin testing is recommended.
Now available in pharmacies, the first of a new class of non-nucleoside reverse transcriptase inhibitors (NNRTIs) has been licensed. Nevirapine (marketed as Viramune) is different from nucleoside reverse transcriptase inhibitors because it binds at a different location on the HIV-1 virus and at a different point in the reproduction process in its effort to block HIV replication. Also, HIV-1 mutant strains, which become resistant to other drugs, have remained sensitive to nevirapine. The Food and Drug Administration (FDA) Antiviral Drugs Advisory Committee recommended that nevirapine be used only in combination therapy, but did not complicate the label by stating whether to include one or two additional drugs. They recommended approval for both treatment-naive and experienced individuals. Although suppression of viral replication is modest, the NNRTIs appear to penetrate the central nervous system and offer an alternative for people either intolerant of or resistant to the currently available nucleoside analogs. A major side effect of the drug is the development of a severe rash. The manufacturer, Boehringer Ingelheim, has promised to issue a booklet on how to manage a nevirapine-related rash. Individuals interested in the patient assistance program may call Boehringer Ingelheim for more information. PMID:11363827
Abstract in english Relatamos o caso de um homem de 50 anos com uma rara associação: tuberculose pulmonar e vasculite leucocitoclástica cutânea. O paciente procurou o pronto atendimento em razão do quadro de cefaléia, artralgia, rash cutâneo e perda ponderal (4 kg) nos últimos 20 dias. A radiografia de tórax, solicitada em consulta ambulatorial prévia, demonstrava cavitação nos lobos médio e superior do pulmão direito, confirmada por tomografia computadorizada. Apresentou bacil (more) oscopia de escarro (coloração de Ziehl-Neelsen) positiva em três amostras consecutivas e biópsia da lesão de pele compatível com vasculite leucocitoclástica cutânea. Foi, então, realizado o diagnóstico de vaculite leucocitoclástica cutânea associada à tuberculose pulmonar. Nosso objetivo é descrever uma associação pouco relatada na literatura médica e discutir seus possíveis mecanismos patogênicos. We report the case of a 50-year-old male with a rare combination: pulmonary tuberculosis and cutaneous leukocytoclastic vasculitis. The patient sought emergency treatment presenting with headache, arthralgia, cutaneous rash, and weight loss (4 kg) in the last 20 days. A chest X-ray, performed in a previous outpatient visit, revealed cavitation in the middle and upper lobes of the right lung, as confirmed by computed tomography. Sputum smear microscopy (Ziehl-Neelsen staining) was positive in three consecutive samples, and the result of the skin lesion biopsy was consistent with cutaneous leukocytoclastic vasculitis. The patient was therefore diagnosed with cutaneous leukocytoclastic vasculitis accompanied by pulmonary tuberculosis. Our objective was to describe a combination rarely reported in the medical literature and to discuss the possible pathogenic mechanisms of this combination.
Abstract in portuguese A doença de Castleman (DC) é uma doença linfoproliferativa não neoplásica rara, de etiologia desconhecida, que se caracteriza clinicamente por adenomegalias isoladas ou múltiplas, podendo ou não estar associada a sintomas sistêmicos, como febre e perda de peso. Estes sintomas podem levar a um diagnóstico equivocado de doença auto-imune e o diagnóstico diferencial deve ser feito através de exame anatomopatológico do linfonodo acometido, que caracteristicamente (more) , na DC, mostra um padrão de células plasmáticas com infiltrado hialino. Os autores relatam o caso de uma paciente de 24 anos de idade, com apresentação inicial de febre, poliartrite e "rash", sugerindo doença de Still do adulto cujo achado anatomopatológico confirmou o diagnóstico de DC. Abstract in english Castleman's disease (CD) is rare nonmalignant lymphoproliferative illness, of unknown etiology, clinically characterized by isolated or multiple adenomegalies, associated or not with systemic symptoms such as fever and weight loss. These symptoms can lead to a wrong diagnosis of autoimmune illness and the differential diagnosis must be made through histological examination of involved lymph nodes, which shows, in the case of CD, a pattern of plasma cells with hyaline infi (more) ltration. A case of a woman of 24-year-old, who initially presented fever, polyarthritis and skin rash, suggestive adult-onset Still's disease is reported; the histological examination confirmed the diagnosis of Castleman's disease.
Abstract in portuguese RACIONAL: Dispositivo intra-uterino pode perfurar o útero e causar várias complicações. OBJETIVO: Descrever um caso de tratamento laparoscópico de periapendicite causada por dispositivo intra-uterino. MATERIAL E MÉTODOS: Jovem do sexo feminino apresentou dor em fossa ilíaca direita de 4 dias de duração. No exame físico, apresentava dor abdominal localizada em fossa ilíaca direita, com discreta renitência de parede e dor à percussão e descompressão brusca na (more) região. A ultra-sonografia evidenciou dispositivo intra-uterino fora do útero, na fossa ilíaca direita. RESULTADOS: À laparoscopia, observou-se massa inflamatória que consistia do dispositivo intra-uterino totalmente bloqueado pelo mesoapêndice e apêndice. Apendicectomia e retirada do dispositivo foram realizadas. CONCLUSÃO: A laparoscopia permite o tratamento adequado da periapendicite causada por dispositivo intra-uterino, inclusive com avaliação adequada de toda a região pélvica para excluir lesões associadas. Abstract in english BACKGROUND: Intrauterine device may perforate the uterus and cause several complications. AIM: To report a case of laparoscopic treatment of peri-appendicitis caused by intrauterine device. PATIENT AND METHOD: A young female presented with pain in the right lower abdomen of 4 days of duration. On the physical examination, she had localized abdominal pain in the right lower abdomen with discrete guarding and pain on percussion and rebound tenderness. Ultrasonography showed (more) an intrauterine device outside of the uterus, in the right lower of the abdomen. RESULTS: At laparoscopy, an inflammatory mass that consisted of the intrauterine device blocked by the mesoappendix and the appendix was observed. Appendectomy and removal of the intrauterine device were performed. CONCLUSION: Laparoscopy allows adequate treatment of peri-appendicitis caused by intrauterine device, inclusive with complete evaluation of the entire pelvic region to rule out associated complications
[figure removed for brevity, see original site] (Released 31 July 2002) This image crosses the equator at about 155 W longitude and shows a sample of the middle member of the Medusae Fossae formation. The layers exposed in the southeast-facing scarp suggest that there is a fairly competent unit underlying the mesa in the center of the image. Dust-avalanches are apparent in the crater depression near the middle of the image. The mesa of Medusae Fossae material has the geomorphic signatures that are typical of the formation elsewhere on Mars, but the surface is probably heavily mantled with fine dust, masking the small-scale character of the unit. The close proximity of the Medusae Fossae unit to the Tharsis region may suggest that it is an ignimbrite or volcanic airfall deposit, but it's eroded character hasn't preserved the primary depositional features that would give away the secrets of formation. One of the most interesting feature in the image is the high-standing knob at the base of the scarp in the lower portion of the image. This knob or butte is high standing because it is composed of material that is not as easily eroded as the rest of the unit. There are a number of possible explanations for this feature, including volcano, inverted crater, or some localized process that caused once friable material to become cemented. Another interesting set of features are the long troughs on the slope in the lower portion of the image. The fact that the features keep the same width for the entire length suggests that these are not simple landslides.
The purpose of this study was to determine the potential role of the sentinel lymph node (SLN) procedure in limited lymph node dissection in patients with apparently localised prostate carcinoma. In 27 patients with organ-confined prostate cancer, a single injection of 0.3 ml/30 MBq{sup 99m}Tc-rhenium sulphur colloid was injected transrectally into the peripheral zone of each lobe of the prostate (total 0.6 ml/60 MBq) under ultrasound guidance. Two hours after injection, scintigraphy was performed. The first step in surgery was the detection and dissection of lymph nodes identified as SLNs. Then, standard lymphadenectomy was performed, consisting in a limited dissection that included all lymph nodes from the obturator fossa and along the external iliac vein. Lymphatic tissue along the hypogastric artery was not systematically removed, except in the presence of SLNs. Mean patient age was 66 years (48-77); the mean serum prostate-specific antigen value was 10.6 ng/ml. In a high proportion of patients (21/27, 77.8%) an SLN was located along the initial centimetres of the hypogastric artery. The second most frequent site of SLNs was in the obturator fossa (11/27 patients, 40.7%), followed by the external iliac area (5/27 patients, 18.5%). Four patients had lymph node metastases, all in SLNs: two in the hypogastric area and two in the obturator fossa. The SLN procedure revealed the individual variability in the lymphatic drainage of the prostate. The main site of SLNs was the hypogastric area, and two of the four metastatic nodes were located at this site. A limited standard pelvic lymphadenectomy, excluding the hypogastric lymph nodes, would have missed half of the lymph node metastases in this study. A radionuclide SLN procedure could assist in the correct staging of patients with early prostate cancer, especially when performing limited lymphadenectomy. (orig.)
Since the mid cranial fossa is composed of various thickness of bone, the tissue inhomogeneity caused by bone would produce dose attenuation in cobalt-60 gamma knife irradiation. The correction factor for bone attenuation of cobalt-60 which is used for gamma knife source is -3.5%. More importantly, nearly all the radiosurgery treatment planning systems assume a treatment volume of unit density; any perturbation due to tissue inhomogeneity is neglected. This study was performed to confirm the bone attenuation in mid cranial fossa using gamma knife. Computed tomography was performed after leksell stereotactic frame had been fixed to the alderson rando phantom (human phantom) skull area. Kodak X-omat V film was inserted into two sites of pituitary adenoma point and acoustic neurinoma point, and irradiated by gamma knife with 14mm and 18mm collimator. An automatic scanning densitometer with a 1mm aperture is used to measure the dose profile along the x and y axis. Isodose curve constriction in mid cranial fossa is observed with various ranges. Pituitary tumor point is greater than acoustic neurinoma point (0.2-3.0 mm vs. 0.1-1.3 mm) and generally 14 mm collimator is greater than 18 mm collimator (0.4-3.0 mm vs. 0.2-2.2 mm). Even though the isodose constriction is found, constriction of 50% isodose curve which is used for treatment reference line does not exceed 1 mm. This range is too small to influence the treatment planning and treatment results. Radiosurgery planning system of gamma knife does not show significant error to be corrected without consideration of bone attenuation.
Twenty five patients with histologically proven medulloblastoma received craniospinal radiotherapy (CSRT) at the Seoul National University Hospital from 1979 to 1984. The extent of tumor removal was biopsy only in 2 patients, partial in 18, and near total in 5. With orthogonal technique of CSRT, mainly 55 Gy was delivered to the posterior fossa(PF). 40Gy to whole brain (WB), and 30 Gy to whole spine (WS). And with AP : PA technique, 50 Gy to PF, 45-50 Gy to WB, and 36 Gy to WS. Complete remission was obtained in 84% of patients. Among 21 CR's 10 failures were observed, thus total failure rate was 56% (14/25). Of 14 failure 13 had the primary failure, 11 failed in primary site alone, 1 failure was combined with ventricular seeding, and another 1 was combined with neck node metastasis. There was 1 isolated spinal failure. Actuarial overall survival rates at 3 and 5 years were 75% and 54%, and disease-free survival rates were 58% and 36%, respectively. Better 5 year disease-free survival was noted in patients with 55Gy to the posterior fossa than those with 50 Gy (62% vs 17%, p<0.05), in patients treated with orthogonal technique than those treated with AP : PA technique (87% vs 12%, p<0.05), and in patients with near total removal than those with partial or less removal of tumor (56% vs 30%, N.S.) Re-irradiation was not satisfactory. No severe late sequelae was noted among the survivors. For the higher control of medulloblastoma, dose to posterior fossa should be at least 55 Gy with orthogonal CSRT to small tumor burden. And dose reduction in the subarachnoidal space might be safe, but optimal dose to the subarchnoidal space should be determined by the thorough tumor staging before radiotherapy.
Although venous air embolism (VAE) in neurological surgery is mainly associated with posterior fossa procedures, this complication may also occur, with comparable severity, in the posterior cervical spine approach in patients who are semi-sitting. We report a patient with a massive VAE that occurred in the semi-sitting position during a posterior approach to an extended cervical-thoracic level (C3-T2) intramedullary tumor, which interrupted the surgical procedure. We discuss the possible causes of air embolism, the anatomic and pathogenetic mechanisms, treatment and preventive measures.
In this study, three primary central nervous system tumors of different histological cell types occurring together without neurofibromatosis are reported. These included a sellar pituitary adenoma with apoplexy, a large torculo-tentorial meningioma in the posterior fossa, and a cervical spinal intramedullary schwannoma. Displacement of primitive multipotent cells in different central nervous system compartments or the oncogenic effects of activated signaling of growth factor receptors are the proposed pathophysiological mechanisms for the simultaneous genesis of different types of tumors. There was associated tonsillar herniation, cervicodorsal syringomyelia, and hydrocephalus. The radiological features and treatment strategy of these rare synchronous tumors are highlighted.
Introduction Intradural spinal lipoma is rare and seen about 1% of all tumors of the spinal cord. Lipomas of the cervical location with intracranial extension are extremely rare and are described as intramedullary or subpial location. Case A 12-year-old female with lipoma of the cervicothoracic spinal cord demonstrated progressive quadriparesis. The patient underwent surgery with decompression of the affected craniocervical location. Discussion In the reported case, we describe a rare intradural lipoma of the cervicothoracic spinal cord with posterior fossa extension in the child, and the relevant English medical literature is reviewed.
