Acute onset of dermatitis, hepatitis, and eosinophilia

A 48-year-old man presented to the emergency department complaining of fever, chills, myalgias, and diffuse abdominal discomfort of four days' duration. A nonpruritic rash had developed on his left palm, arms, legs, and buttocks on the fourth day. He had not had respiratory symptoms, nausea, vomiting, or diarrhea.     

Torsion of a malignant undescended testis

Cryptorchid testis have a greater risk of malignant change than do normally descended testis. The undescended testis would also be susceptible to torsion by the mechanism of increase in testicular size. A 36-year-old man of torsion of malignant undescended testis is presented. He was diagnosed as having incarcerated inguinal hernia on his first visit to general surgeon due to acute left lower abdominal pain. At laparotomy, a 7.5 x 5.5 x 3.0 cm3, greyish tan color mass was found. The pathological diagnosis is choricarcinoma and teratoma, mixed germ cell tumor. We would emphasise that in any patient presenting with acute abdominal symptoms and an absent scrotal testis, the possibility of a complication of torsion of undescended testis should be considered.     

Locus heterogeneity in autosomal dominant congenital external ophthalmoplegia (CFEOM)

An autopsy case of retroperitoneal leiomyosarcoma of a centenarial male is described. He complained of abdominal pain in his left side 1 month before his death. Ultrasonography and computed tomography revealed a large mass in the left abdominal cavity. At autopsy, a circumscribed mass, 15 cm in diameter, was found in the left-upper abdominal cavity, and seemed to be derived from the retroperitoneum in an exophytic manner. Histologically, spindle cells with slight eosinophilic cytoplasm and blunt-ended nuclei showed interwoven fascicular growth, and mitotic figures were easily encountered. Immunohistochemically, the tumor cells were labeled by alpha-smooth muscle actin and vimentin. To our knowledge, this case of leiomyosarcoma has presented in the oldest patient ever reported. The rarity of soft tissue sarcomas in the extremely elderly is also discussed.     

Self-control techniques as an alternative to pain medication.

A 65-yr-old retired army officer with a productive work history was admitted to a psychiatric ward with symptoms of chronic abdominal pain and social withdrawal. For several years his pain had been managed with Talwin (pentazocine), which was self-administered intramuscularly 6 times/day. The patient was taught self-control of his pain through a program of relaxation, covert imagery, and cognitive relabeling. He was then withdrawn from medication by diluting the Talwin with increasing proportions of normal saline. Follow-up showed the patient to be socially active, without medication, and more successfully controlling his pain. Results are discussed in terms of punishment, self-attribution of change, the nature of pain, and the ethical issues involved in instituting a treatment procedure without the completely informed consent of the patient. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Isolation and absolute structures of enantiomeric 1,2-bis(4-hydroxy-3-methoxyphenyl)-1,3-propanediol 1-O-glucosides from the bark of Hovenia trichocarpa

The common diagnoses in low back pain are lumbar strain, lumbosacral radiculopathy, osteoarthritis, degenerative disc disease, spinal stenosis, and sacroiliac joint dysfunction. Unusual causes of low back pain that have been previously identified include abdominal aortic aneurysms, pelvic neoplasms, and retroperitoneal hemorrhages. This report describes a case of back pain that was apparently caused by a duodenal ulcer. A 54-year-old man with no significant medical history presented with a complaint of mid to low back pain (T10-L2), which was diagnosed as joint dysfunction. A comprehensive treatment program was prescribed and the patient was instructed to return to clinic in 4 weeks. Three weeks later, he experienced a syncopal episode followed by coffee ground emesis. He immediately sought medical attention at an emergency room, where he was admitted to the hospital with a diagnosis of upper gastrointestinal bleed. Esophagogastroduodenoscopy showed a large duodenal ulcer, and the patient underwent vagotomy and pyloroplasty. He returned to his physiatrist's office 3 weeks after hospital discharge with minimal back pain. The cause of the back pain proved to be referred visceral pain from his duodenal ulcer. This case is presented to reemphasize the need to include the uncommon phenomena in the differential diagnosis of low back pain.     

Ultrasmall superparamagnetic iron oxide particles (AMI 227) as a blood pool contrast agent for MR angiography: experimental study in rabbits

We report a case of successful surgical management of a potentially life-threatening complication of aortoiliac stent placement. A 59-year-old man who had Leriche syndrome underwent bilateral iliac artery and infrarenal aortic stent placement at another institution. His history was significant for retroperitoneal lymph node dissection at 19 years of age for testicular cancer. One week after stent placement, the patient was readmitted with abdominal pain, poor oral intake, and diffuse intermittent tenderness. Evaluation with computed tomographic scanning and endoscopy was unremarkable, and the patient was discharged. He was admitted to our institution 1 week later with persistent abdominal pain. A computed tomographic scan of the abdomen revealed a large pseudoaneurysm of the abdominal aorta. The patient underwent urgent exploration, and exclusion of his infrarenal aorta was achieved with aortobifemoral bypass grafting. After the operation, the patient's course was complicated by a large paraduodenal hematoma, which resulted in a gastric outlet obstruction, which was managed without operation. This case illustrates a potential life-threatening complication of extensive stent placement for aortoiliac occlusive disease. Injury to the abdominal aorta must be considered in a symptomatic patient after the placement of stents in the aortoiliac region, beyond the immediate periprocedural period.     

Benjamin Kleinmuntz (1930-2006).

In the 1960s, the idea that clinical judgments should be aided, or even replaced, by computerized algorithms was quite radical. Computerized interpretation of standardized tests is accepted now, although its role remains controversial. Benjamin Kleinmuntz was a pioneer in the study of computers in clinical reasoning and a founder of the field of judgment and decision research. He passed away at his home inWilmette, Illinois, on June 28, 2006, at the age of 76. Although he lived with a transplanted heart for almost 11 years, he died of complications of unrelated abdominal surgery. Ben's early research concerned statistical methods for identifying psychopathologies and interpreting personality profiles. Ben then focused on investigating the use of computers in clinical diagnosis. Ben also wrote or cowrote textbooks on general psychology, abnormal psychology, and personality assessment. He was also a great teacher and advisor, with a unique personal style and an emphasis on both rigor and relevance. He received multiple awards for teaching excellence, and his two all-University teaching awards were as important to him as his many books, publications, and professional recognitions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A 64-year-old man with recurrent blurred vision and an abdominal mass

We report a 64-year-old man with recurrent bouts of blurred vision who died after developing an abdominal mass. He was well until June of 1985 when he was 59-years-old when he had an acute onset of loss of vision in his right eye. He was treated by prednisolone with a complete remission. In August of 1986, he had another bout of blurring of vision in his left eye. Once he lost his left vision completely, from which he showed slow recovery. In January of 1987, he developed blurring of his right eye and loss of pain and touch sensation in his right leg. Since then he repeated loss of vision in his right or left eye five times, and he was admitted to our hospital in May of 1990. On admission, he was alert and oriented. General physical examination was unremarkable. Neurologic examination revealed bilateral optic nerve atrophy. He could not discriminate light or dark by either eye. Other cranial nerves were unremarkable. He could walk in a wide-base only with support; spasticity was noted in his left leg. Muscle strength was preserved. Deep reflexes were exaggerated in both legs with extensor plantar reflex bilaterally. Pain and touch sensation was decreased in the left leg by 30%, and vibration was diminished in both feet. Position sense was preserved. Routine blood counts and chemistries were unremarkable. Cranial MRI scans revealed multiple high-signal intensity lesions in both pontine bases, basal ganglia, thalami, and in the deep cerebral white matters. He was treated with oral prednisolone, plasmapheresis, lymphocytapheresis, and then immuran. His vision showed only slight recovery to discriminate light and dark. In October of 1990, slight weakness appeared in his both legs. In December of that year, he developed nausea, and a fiber colonoscopic study revealed a stenosis in the transverse colon. In March of 1991, he developed anemia and liver dysfunction. In July of that year, jaundice appeared, and his serum bilirubin was increased. In October, his leg weakness became more prominent, and his cranial CT scans at that time revealed a low density change in the right cerebellum in the right superior cerebellar artery territory; in addition, multiple low density spots were scattered to be seen in both cerebral hemispheres including the basal ganglia and thalamic areas with ventricular dilatation and cortical atrophy.(ABSTRACT TRUNCATED AT 400 WORDS)     

Hybridization between wapiti (Cervus elephus manitobensis) and sika deer (Cervus nippon): a comparison of two artificial insemination techniques

We describe a 42-year-old man with von Hippel-Lindau disease and islet cell tumor of the pancreas. He had retinal and cerebellar hemangioblastomas. His sister had pheochromocytoma. A pancreatic tumor was detected by ultrasonography at his periodical medical checkup. Contrast enhanced computed tomography and abdominal angiography revealed a hypervascular tumor in the pancreatic head. Histological examination of the resected tumor revealed characteristics of islet cell tumor of the pancreas, which was positive for chromogranin-A, S-100 protein, and pancreatic polypeptide, but was negative for insulin, gastrin, glucagon, somatostatin, vasoactive intestinal peptide, serotonin, and adrenocorticotropic hormone.     

Intermittent edema of the upper and lower extremities and the abdominal wall caused by membranous stenosis of the superior vena cava and membranous obstruction of the inferior vena cava

We report on a 38-year-old patient with intermittent edema of the lower legs, arms and abdominal wall. The cause for his tendency to develop edema was a membranous obstruction of the inferior vena cava and a membranous stenosis of the superior vena cava. The etiology of these anomalies of the vena cava suggests a congenital malformation. In consideration of the cases of inferior and/or superior vena cava-anomalies published to date the patient received an anticoagulant therapy (coumarin) and treatment with graduated compression stockings. He now complains from time to time of a sensation tension in the lower legs after prolonged standing or sitting. Edema of the upper and lower extremities and the abdominal wall have disappeared.     

Percutaneous ethanol injection for unresectable pancreatic cancer-report of two cases

Two cases of unresectable pancreatic cancer underwent percutaneous ethanol injection (PEI). The first was a 65-year-old man with a 43 x 39 mm mass in the head of the pancreas. He received PEI (total 38.5 ml of ethanol) 6 times. Serum CA19-9 decreased from 3,800 U/ml to 1,700 U/ml. The patient was dead 6 months after PEI. Autopsy revealed coagulative necrosis at the site of ethanol injection. The second case was a 66-year-old man with a 70 x 50 mm mass in the body of the pancreas. He was treated by PEI (total 10 ml). After PEI, his abdominal pain was relieved considerably. He died 4 months after PEI treatment. These findings suggest that PEI may be useful not only for pain control but also for tumor reduction of unresectable pancreatic cancer.     

The effect of a preparation from the horns of the saiga antelope on the goal-directed drinking behavior of rats

We analyzed 79 consecutive patients with aneurysms and found a patient who lacked type III collagen. Collagen was extracted from the skin, and the lack of type III collagen was determined by means of sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Only 1 of the 79 patients was found to lack type III collagen. This patient was a 55-year-old man who had sustained an abdominal aortic aneurysm and aortic dissection. He did not show any of the typical clinical symptoms of Ehlers-Danlos syndrome type IV, such as hyperextensible skin and joints. He had none of the usual risk factors nor any clear family history of the syndrome. Furthermore, his collagen fibrils demonstrated a homogeneous appearance. This case may represent a new form of type III collagen deficiency.     

An autopsy case of renal failure as its cause of death in a patient with primary hyperparathyroidism associated with chronic pancreatitis

This paper presents a 59-year-old man who was admitted to our hospital because of abdominal pains in 1973. He had pancreatic calcification and showed high levels of serum amylase, Ca, and PTH. He was diagnosed as primary hyperparathyroidism with chronic pancreatitis. After excision of an ectopic parathyroid adenoma, serum Ca levels were decreased and normalized by dihydrotachysterol p.o. At the same time his symptoms disappeared. The exocrine and endocrine pancreatic functions, however, decreased gradually. Diabetes mellitus appeared in 1975 and he required insulin injection since 1983. In spite of the treatment, his diabetic control was poor. Seventeen years later in 1992, he showed hypertension and edema (nephrotic syndrome). Because of renal failure, he underwent hemodialysis and passed away due to myocardial infarction in 1993. Autopsy findings showed existence of diabetic nephropathy as the cause of renal failure. Clinical course of this patient suggests that severe complications occur even in pancreatic diabetes and that we have to control diabetes strictly in pancreatic diabetes as well as in primary diabetes.     

Multiple idiopathic arterial aneurysms in children: a case report and review of the literature

A 6-year-old boy from China presented initially at 2 years of age with a pulsatile mass in his right antecubital fossa. He was not fully evaluated until the age of six years, when pan-angiography and computed axial tomography scan revealed multiple aneurysms of his right brachial artery, right radial artery aneurysms, an infrarenal aortic aneurysm, and a right internal carotid artery aneurysm in the region of the cavernous sinus. The patient underwent uneventful repairs of both the abdominal aortic aneurysm and the multiple aneurysms of the right arm. Pathologic evaluation was significant for medial fibrosis of the arterial wall with decreased and disordered elastin fibers. Review of the previously reported cases in children indicate the upper extremity arteries are involved in 92% of patients, the aortoiliac region in 92% of patients, and the renal/mesenteric vessels in 77% of cases. Lower extremity and cerebrovascular arteries are involved to a lesser extent. Children with peripheral aneurysms should have pan-angiography performed before treatment is begun. Surgical repair in these cases has been excellent.     

Origin of laparoscopy: coincidence or surgical interdisciplinary thought?

The history of laparoscopy illustrates the interaction between the many areas of medicine and technology; in fact, the development of that technique is a cumulative effort of internists, gynecologists, and surgeons. At the beginning of our century, however, neither group was particularly open to the idea of scholarly exchange. In this respect, an early pioneer of laparoscopy, Georg Kelling (1866-1945) of Dresden and the story surrounding the invention of the laparoscopy are interesting exceptions. Although Kelling regarded himself a surgeon, he devoted a great deal of energy to the development of "nonsurgical" methods of treatment. He spent a great part of his life determining stomach capacity, constructing a semiflexible tube endoscope (straightened after the insertion), and attempting to alleviate gastrointestinal bleeding by means of high-pressure pneumoperitoneum (lufttamponade). To observe the effects of insufflation on abdominal organs, Kelling introduced a cystoscope into the abdominal cavity. In fact, the invention of "celioscopy" or laparoscopy (1901) can be called a synthesis of Kelling's work with insufflation and his fascination with endoscopy.     

Inflammatory myofibroblastic tumor in children

The authors presented the cases of two children with inflammatory myofibroblastic (IMF) tumor and reviewed the literature to facilitate the preoperative recognition, delineate the clinical features, and describe the natural history of this entity. The first child had IMF tumor arising from the mesentery of the small intestine. He presented with an abdominal mass associated with severe inflammatory response manifested by fever, impaired growth, thrombocytosis, and microcytic, hypochromic anemia. After surgical resection, his fever resolved and his growth rate and the laboratory abnormalities normalized. Five months after initial diagnosis, the fever, anemia, and thrombocytosis recurred along with two tumors arising from the omentum and the abdominal soft tissue. After the second surgery, he remains free of recurrent disease for 30 months. The second child presented with a lung mass that was radiologically indistinguishable from pulmonary sequestration. After surgical resection, she remains free of recurrent disease for 18 months. IMF tumor should be considered in any solid tumor that occurs in association with a chronic inflammatory response. IMF tumor should also be considered in the differential diagnosis of pulmonary sequestration.     

Predicting recovery from common whiplash

Epididymo-orchitis (EO) is said to be extremely rare in infants and children. It is usually diagnosed after scrotal exploration for symptoms which mimic manifestations between EO and torsion of the cord and its appendage. The pathophysiologic mechanisms for the development of EO are not well known. Although some causative agents of EO have been reported, in most cases there was no clear etiology. We report a 3-month-old male infant who had been well until the day prior to admission when irritability, left testicular swelling, scrotal erythema with a hot sensation were noted by his mother. He was treated medically after excluding the possibility of an emergent surgical condition (such as torsion of the cord and its appendage, or incarcerated hernia) by means of physical examinations, abdominal and inguino-scrotal sonography, laboratory studies, and testicular radionuclide scintigraphy. A catheterized sample of urine for culture yielded Escherichia coli. There was the possibility that the EO was caused by hematogenous rather than local spread from an infection of the urinary tract. He was treated with a 10-day course of intravenous cefazolin and amikacin. Following this, he improved clinically and a repeat catheterized urine sample remained sterile on culture. In addition, a bilateral inguinal hernia and hydrocele were detected by inguino-scrotal sonography and were operated on the 11th hospital day. He was discharged on the 16th day of hospitalization and remained well 11 months after discharge.     

Frank Landy (1942–2010).

Frank Landy died peacefully with his family by his side on January 12, 2010. His legacy to the education, research, and practice of industrial and organizational (I/O) psychology will live on in his students, his books and articles, and his ability to define and shape science and practice. Landy believed that good practice followed from good science and spent his career applying what he learned from his own research and the work of others to diverse problems related to selecting employees, managing performance, creating successful human–machine interfaces, and ensuring fair employment practices through his litigation-related work. He was the definition of a scientist–practitioner. Landy was born in Philadelphia on December 30, 1942. He began his study of psychology at Villanova University, where he received his bachelor’s degree in 1964. He earned a master’s degree (1966) and his doctorate (1969) from Bowling Green State University. Landy joined the faculty at Pennsylvania State University, and during his 26 years there he helped to build one of the most successful I/O psychology programs in the country. He was a member of many professional organizations and won many awards for his outstanding contributions to the field. He began his consulting career in 1965 and helped hundreds of organizations by applying psychological research to the solution of practical problems in human resource management, employee relations, and work motivation. Landy was an avid runner, completing more than 60 marathons, and he often participated in runs at the SIOP conferences. He played and collected guitars and was a great lover of music, often playing and singing publicly. He is survived by his wife Kylie Harper, his two daughters Erin and Elizabeth, his son-in-law George, and his four grandchildren. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

John Watson Murray Rothney (1906–1987).

Presents an obituary for John Watson Murray Rothney, who died in Roswell, New Mexico, on July 1, 1987, after a lengthy illness. He was one of the early and continuing influential persons in guidance, counseling psychology, and counselor education and was particularly famed for his longitudinal research in school counseling. He attributed his early interest in longitudinal research to W. F. Dearborn with whom he worked on the Harvard Growth Studies involving 2,000 school children in the early 1930s. He also worked on the Dartmouth Study on Vision and Motivation in the late 1930s. John Rothney was deeply committed to education, to the University of Wisconsin, to his family, to his colleagues, and to his students. He was highly respected and left his mark and influence on all individuals and institutions that had the good fortune to experience involvement with him. He is survived by his wife, Ruth, two sons, Jim and Scott, and two grandchildren. (PsycINFO Database Record (c) 2010 APA, all rights reserved)