Hepatic amebiasis: an unusual clinical presentation

BACKGROUND: Painful liver enlargement with fever are common signs of hepatic ambiasis. Exceptionally, atypical signs may also occur including symptoms suggesting renal sepsis. CASE REPORT: An 18-year-old woman from the New Caledonia was hospitalized in metropolitan France for suspected right-sided acute pyelonephritis. Urinalysis was normal and the kidney ultrasound suggested the need for an abdominal CT-scan which evidenced a voluminous 10-cm abscess pus. Serology for amebia was positive, confirming the diagnosis of hepatic amebic abscess. Outcome was rapidly favorable with intravenous anti-parasite treatment amebic abscess. Outcome was rapidly favorable with intravenous anti-parasite treatment and percutaneous drainage. DISCUSSION: Atypical signs of hepatic ambiasis may mislead diagnosis. The absence of a fetid odor at puncture helps guide diagnosis, confirmed by serology. Percutaneous drainage can hbe proposed for voluminous abscesses or if the risk of extrahepatic complications is eminent.     

Primary hepatic lymphoma: unusual presentation and clinical course

Although primary hepatic lymphoma is rare, it should be considered in the differential diagnosis of a hepatic tumor, because it is usually associated with a favorable prognosis. This report describes an unusual case of primary hepatic lymphoma with an atypical presentation (only mild, right upper quadrant pain and no hepatomegaly) followed by acute fulminating hepatic failure, metabolic acidosis, followed by a rapidly fatal course. A review of the literature and discussion of the disease are also presented.     

Hepatic adenoma associated with oral contraceptive use: an unusual clinical presentation

A young woman who had taken contraceptive steroids for many years had the acute onset of abdominal pain because of central necrosis and hemorrhage into a hepatic adenoma. She had multiple lesions confined to one lobe of the liver. Persistent pyrexia and leukocytosis were also prominent clinical findings. She has had no evidence of recurrence of this problem during the seven years following right hepatic lobectomy. A review of the anabolic and contraceptive steroid-associated hepatic neoplasms is presented with comments directed toward the recognition of the critical clinical sequelae that can befall the patient with hepatic adenoma. Although all the patients in the steroid-treated group have tumors with benign and striking histologic similarity, microscopic evidence of malignant invasion of surrounding tissue is occassionally noted.     

Secondary membranoproliferative glomerulonephritis due to hemolytic uremic syndrome: an unusual presentation

In vitro selection can be used to generate nucleic acid ligands (aptamers) to target molecules ranging in size and structure from cations to cells. However, the selection process is repetitive and time-consuming. We have automated a protocol for in vitro selection using an augmented Beckman Biomek 2000 pipetting robot. The automated selection procedure requires the integration of four devices and the optimization of four molecular biology methods, and is one of the most complex automated protocols attempted to date. Initial attempts at selection yielded robust replication parasites, but optimization of the automated selection procedure suppressed the emergence of these parasites and led to the selection of true nucleic acid ligands. Automated selection can now be used to generate nucleic acid aptamers in days rather than weeks or months.     

Multiple system atrophy: clinical presentation and diagnosis

Multiple system atrophy (MSA) describes a relatively uncommon, debilitating disorder that is frequently misdiagnosed as Parkinson's disease. Patients with MSA show various combinations of parkinsonism, cerebellar ataxia, pyramidal signs and progressive autonomic failure, especially cardiovascular and urologic autonomic dysfunction. Few treatment options exist. Although some patients initially respond well to dopaminergic treatment for their parkinsonian symptoms, striatal degeneration occurs, and levodopa often becomes ineffective. Thus, physicians may provide only symptomatic treatment and support for patients with MSA. In this paper, we present a case study of a 68-year-old woman who came to the Vanderbilt Movement Disorders Clinic with severe autonomic dysfunction and parkinsonism, previously diagnosed as Parkinson's disease. Following autonomic function tests as well as clinical evaluation, she was diagnosed with MSA and began treatment for orthostatic hypotension and micturition dysfunction.     

Esophageal perforation. An unusual presentation with a benign clinical course

A case of esophageal perforation occurring in a 75-year-old man is presented. The clinical presentation was benign and the diagnosis of esophageal perforation was made incidental to an upper gastrointestinal barium examination. Conservative management consisting of nasogastric suctioning, antibiotics and antacids was effective in minimizing the clinical course. This represents a rare instance of a successful nonsurgical approach to esophageal perforation.     

Myocardial rupture after acute myocardial infarct: 2 cases with an unusual clinical presentation

Myocardial rupture is the second most common reason for in-hospital mortality in patients with acute myocardial infarction, accounting for 8-17% of deaths. The clinical presentation varies due to the possibility of rupture in three main locations: free left ventricular wall (85%), interventricular septum (10%), and papillary muscle (5%). Hypotension, long persisting or repeated chest pain, syncopes, new heart murmurs or weak action should draw attention to the possibility of myocardial rupture, apart from the classical sign of upper inflow congestion. In about 48% of cases immediate surgical intervention can save life. We present two unusual cases of myocardial rupture. Case 1 shows left ventricular free wall rupture with additional rupture of an accessory posterior papillary muscle but without changes in hemodynamic parameters; case 2 involves a rupture of the free left ventricular wall which the patient survived without surgical intervention.     

Huntington's chorea: clinical aspects, genetics and current diagnosis

Huntington's disease is a late manifesting autosomal dominant neurodegenerative disorder. It is characterized by motor disturbance, loss of cognitive functions and psychiatric manifestations. The disease causing mutation, an unstable DNA sequence in the coding region of the Huntington gene on chromosome 2p, has recently been identified. A trinucleotide [CAG] repeat is expanded over the normal range and can be easily detected by standard laboratory methods. Accurate genetic testing can now be offered in clinically questionable cases and to presymptomatic subjects at risk for Huntington's disease. Furthermore, there is a correlation between the size of the expanded CAG repeat and the age of onset in affected individuals. The predictive value of this correlation, however, is limited due to the range of onset ages found at a given repeat length in large series of patients. Expanded triplet repeats exhibit a marked instability especially in male meiosis with a tendency to further increase during transmission over the generations. This is likely to be the molecular mechanism explaining anticipation, as well as the occurrence of juvenile cases and new mutations.     

The watermelon stomach: clinical presentation, diagnosis, and treatment

The watermelon stomach syndrome is an increasingly recognized cause of persistent acute or occult gastrointestinal bleeding, typically in elderly women. This disorder often presents with severe iron deficiency anemia, and a variety of associated conditions including autoimmune disease, cirrhosis, achlorhydria, and hypochlorhydria. Diagnosis is made by the characteristic endoscopic appearance of visible linear watermelon-like vascular stripes in the antrum. Histology confirms the vascular nature of this disorder, showing dilated and thrombosed capillaries in the lamina propria, associated with reactive fibromuscular hyperplasia. The optimum treatment of choice is not known. Several treatment options, including surgical antrectomy, and endoscopic photocoagulation with Nd:Yag laser, heater probe therapy, and bipolar electrocautery, have yielded excellent results. Pharmacological agents have also been used to treat selected numbers of patients, most of which comprise a small number of case reports.     

Hepatic cystadenoma: an unusual presentation

A 53-yr-old woman with a history of hepatic cystadenoma 25 yr before presented with a simple hepatic cyst, which evolved over 9 yr into a complex cystadenoma with septations and internal bleeding. She was treated with a left hepatectomy. Review of the literature shows that hepatic cystadenomas, although rare, frequently can recur years later and have potential for malignant transformation. Histologic similarities of one variant with ovarian stroma raises interesting possibilities regarding the origin of these lesions. The best treatment results are obtained with radical excision.     

Prevalence, genetics and clinical presentation of chronic granulomatous disease in Sweden

To estimate the prevalence of chronic granulomatous disease (CGD) in Sweden, an inquiry asking for known and possible CGD cases was mailed to paediatric, internal medicine and infectious disease departments all over Sweden. The detected patients were characterized as to genetics and the clinical presentation. Twenty-one patients (belonging to 16 different families) were found, corresponding to a prevalence of approximately 1/450,000 individuals. The patients with X-linked disease, lacking a functional gp91phox protein (n = 12), comprised 57% and 43% of the patients had an autosomal recessive (AR) disease lacking p47phox (n = 7) or p67phox (n = 1), respectively. All unrelated patients with X-linked disease displayed different gene abnormalities such as point mutations predicting nonsense (n = 3), missense (n = 1) or splice site mutations (n = 2), but also a total deletion and a unique 40 base pair duplicature insertion. The patients with p47phox-deficiency showed a GT deletion at a GTGT tandem repeat, and the p67phox-deficient patient displayed a heterozygous in-frame deletion of AAG combined with a large deletion in the other allele. Three patients died during the study period, two from pseudomonas cepacia infections. Patients with X-linked disease had more frequent infections (mean of 1.7 per year), than the patients with AR inheritance (0.5 infections per year). The most common infections were dermal abscesses (n = 111), followed by lymphadenitis (n = 82) and pneumonias (n = 73). Inflammatory bowel disease-like symptoms, mimicking Crohn's disease of the colon, was seen in three CGD patients.     

An unusual clinical course of a hormone-secreting gastrointestinal tumor: a case presentation from clinical practice

The gastrinoma was first described in 1955 by the surgeons Zollinger and Ellison. The basic characteristic of this disease is an endocrine tumor of the gastrointestinal tract, which secretes gastrin. There is a hypersecretion of gastric juice and recurrent gastric, duodenal and jejunal ulcers. Herein, the case of a 49 year-old female is presented. In 1982, two liver tumors, sized 10 and 6 cm, were discovered in the right and left lobes of the liver, respectively. A duodenal ulcer was also found. During explorative laparotomy, a liver biopsy specimen was obtained and defined pathohistologically as a metastatic, small cell epithelial tumor with an organoid endocrine pattern, morphologically corresponding to tumors of the APUD (Amine Precursor Uptake and Decarboxylation) series. The gastrinoma was verified by immunohistochemical staining. Serum gastrin values exceeded normal values by 10 times. The patient refused further treatment at that time. In the following years, she was treated conservatively several times for sequelae of ulcer disease. For the past three years, she has been treated as an outpatient, mostly for chronic diarrhea.     

Metastatic malignant melanoma: an unusual case presentation

Secondary involvement of the genitourinary tract with malignant melanoma is a common autopsy finding, but rarely evident clinically. We report a rare case involving a previously asymptomatic patient presenting with gross hematuria and a large renal mass, which was found to be metastatic melanoma. We propose that metastatic melanoma to the kidney, although rare, be considered in the differential diagnosis of disease processes causing hematuria.     

Case report: an unusual presentation of gout

The efficacy of ear canal flushing and ear canal and mouth swabbing methods for the isolation of mycoplasmas was investigated in 39 goats. Of the 19 goats positive for Mycoplasma spp., 14 (73.7%) were positive with the ear canal flushing method, 4 (21.0%) were positive with both ear canal flushing and mouth swabbing methods, and 1 (5.3%) was positive by the mouth swabbing method. Mycoplasma arginini, M. mycoides subsp. mycoides, and M. mycoides subsp. capri were identified by direct immunofluorescence and growth inhibition tests. Previous reports on the isolation of M. arginini from the ear canal of goats were not found in the literature.