Elastofibroma dorsi: prevalence in an elderly patient population as revealed by CT

OBJECTIVE: We wanted to determine the prevalence and appearance of elastofibroma dorsi in an elderly patient population (n = 258) who underwent CT of the chest for reasons other than to evaluate posterolateral chest wall pain, stiffness, or a mass. CONCLUSION: Five elastofibromas were detected in four patients; none of these elastofibromas were noted at initial examination. Our study suggests that the prevalence of elastofibroma dorsi revealed by CT is 2%, which is lower than the 11-24% found in autopsy series but higher than expected for such a rare tumor. Elastofibroma dorsi typically has a layered appearance on CT; however, in our study, homogeneous soft-tissue attenuation was noted. The diagnosis is often missed prospectively. Familiarity with the location and imaging appearance of elastofibroma dorsi may enhance detection and characterization of posterolateral chest wall masses in elderly patients.     

Lymphoepithelial cysts of the pancreas: demonstration of lipid component using CT and MRI

We present two cases of surgically proven lymphoepithelial cyst (LEC) of the pancreas that had a lipid component visualized by CT and MRI. Identification of this component in a pancreatic cystic lesion is a key to favor the diagnosis of LEC or splenic epidermoid cyst over other cystic lesions when the lesion is noted in an elderly patient.     

Local resection of pulmonary lesions by Nd-YAG laser without suturing

Local excision of 67 pulmonary lesions in 5 patients was performed with the Nd-YAG laser. There were 2 women and 3 men with an average age of 68 years. The patients consisted of three cases of metastatic lung cancer (65 lesions), one hamartoma (One lesion) and one organized pneumonitis (one lesion). The lesion was first enucleated by a contact method using an Nd-YAG laser scalpel, then the crater of the resected lesion in the normal lung tissue was coagulated with a defocused laser beam. The craters of 52 of the 67 resected lesions which were shallow seated in the lung were left open, but the other 15 resected lesions were closed with sutures. Total blood loss was less than 100 ml. There was no bleeding or air leakage (30 cm water pressure) during the post operative days in 4 of the 5 patients, but one patients (one lesion) had to be treated by bronchoscopic endobronchial embolization against a persistent air leak. This lesion was 2.5 cm in diameter and 4 cm deep in the lung on CT. The other lesions were also measured by CT. The tumor size was 1.4 +/- 0.7 cm and the depth was 2.4 +/- 1.0 cm. The Nd-YAG laser is very suitable for local resection of peripheral lung lesions without suturing.     

Genetic relationship between dopamine transporter gene and schizophrenia: linkage and association

This experiment was aimed at comparing the sensorimotor correlates of fimbria-fornix lesions made with either a classical aspiration technique that also removes part of the overlying cortical structures, or an electrolytic one that does not encroach upon these cortical structures. About 4 months after lesion surgery, Long-Evans female rats which had sustained an aspiration or an electrolytic fimbria-fornix lesion at the age of 90 days were tested to measure their beam-walking performance as an index for their sensorimotor capabilities. We found that after an aspiration lesion, the rats presented sensorimotor deficits which did not occur after an electrolytic lesion. After having found that electrolytic lesions of the fimbria and the fornix produced neurochemical deficits (in the dorsal hippocampus) and cognitive alterations close to those resulting from aspiration lesions, it is concluded from the present experiment that the electrolytic lesion technique is an interesting alternative to an aspiration technique, essentially because the former does not induce the sensorimotor deficits due to the partial damage that an aspiration technique produces in the medial parietal cortex. As the electrolytic lesion technique may minimize the risk of introducing a sensorimotor bias in the accuracy of cognitive evaluations, the present result might be of interest to neuroscientist using a fimbria-fornix lesion paradigm in order to investigate the efficacy of drugs, grafts or other treatments on the recovery from cognitive deficits.     

Coronary stenting after rotational atherectomy in calcified and complex lesions. Angiographic and clinical follow-up results

BACKGROUND: Treatment of calcified (in contrast to simple) lesions with PTCA has been associated with a lower success rate and more procedural complications. Rotablation can improve acute results, but the high restenosis rate remains a problem. The purpose of this study was to evaluate the clinical and angiographic outcome of patients with complex and calcified lesions treated with a combination of rotablation and stenting. METHODS AND RESULTS: Seventy-five consecutive patients with 106 lesions had rotablation prior to coronary stenting. Intravascular ultrasound-guided stenting was used without subsequent anticoagulation in 93% of patients. Procedural success was achieved in 93.4% of lesions. Acute stent thrombosis occurred in two lesions (1.9%), and subacute stent thrombosis in one lesion (0.9%). Angiographic follow-up was performed in 82.5% of lesions at 4.6 +/- 1.9 months with an angiographic restenosis rate of 22.5%. Clinical follow-up was performed in all patients at 6.4 +/- 3 months; target lesion revascularization was needed in 18% of lesions; Q-wave myocardial infarction occurred in 1.3%, coronary bypass surgery in 4.0%, and death in 1.3%. CONCLUSIONS: Optimal coronary stenting after rotablation in calcified and complex lesions can be performed with a high success rate, an acceptable rate of procedural complications, and a low rate of stent thrombosis. This approach was associated with a low incidence of angiographic restenosis compared with results usually obtained with other interventional strategies in calcified and complex lesion subsets.     

Actinomyces meyeri cutaneous actinomycosis with pulmonary localization

Infections due to Actinomycosis species are located in the cervico-facial region in 50 to 65 percent of the cases. Extra-cervical cutaneous lesions are exceptional. The most frequently encountered germ is Actinomyces israeli, observed in 85 percent of the cases. We report the case of an Actinomyces meyeri infection which presented as a leg abscess and a pulmonary lesion. There was no cervico-facial localization. There was however a chronic parodontitis. A second germ, Capnocytophaga sp. was isolated from the abscess. This case is of particular interest because of the extracervical localization and the rare species isolated (17 other cases of Actinomyces meyeri infection have been reported). The mechanism of the infection can be better understood in light of pulmonary lesions in the lower right lobe due to inhalation and the coexistence of a buccodental germ in the culture of the leg abscess: buccodental origin of the germ, pulmonary lesion secondary to inhalation, septicaemic dissemination with cutaneous metastases.     

Why are most drowning victims men? Sex differences in aquatic skills and behaviors

Two biopsy cases of elastofibroma--one unilateral and one bilateral--are described. A study of 100 autopsies revealed 13 elderly patients with elastofibroma. Males (n = 10; 16.9%) were more affected than females (n = 3; 7.3%). Pre-elastofibroma-like morphological changes (e.g. few or many degenerated elastic fibres) were observed in 81% of the autopsies. Minor pre-elastofibroma-like changes were seen in males and major changes predominantly in females. In addition to physiological ageing as yet unknown factors, rather than abnormal elastogenesis or degeneration, seem to be involved in this pseudotumour.     

Bone biopsy

Neoplasia is the most common cause of bone lesions in small animals. A definitive diagnosis is required to determine an accurate prognosis and to formulate effective treatment options. Each lesion should be characterized as accurately as possible by evaluation of patient history, signalment, laboratory findings, and the radiographic appearance and location of the lesion. A bone biopsy is recommended for lesions that require histological characterization or culture and susceptibility testing. The biopsy technique of choice should be properly planned to provide accurate sampling of the lesion, to produce the least morbidity possible, and to avoid interferences with future surgical treatment. Approximately 94% of lesions can be definitively diagnosed on the first biopsy attempt if the center of the lesion and the transitional zone between the lesion and normal bone are accurately sampled. Use of a guide wire and prebiopsy radiographs help ensure accurate sampling. A diagnosis of reactive bone is usually an indication for a second biopsy or for close clinical and radiographic monitoring of the lesion.     

Scintimammography using Tc-99m tetrofosmin

TIM (Zeppelin Chirurgische Instrumente GmbH, 82 049 Pullach, Germany) is a tomographic imaging system which enables surgeons to visualize the pathologic lesions three dimensionally in relationship to the surrounding structures. The distance and the angle between the pathologic lesion and the anatomical and/or bony landmarks as well as the volume of the mass lesion can be measured. Therefore an accurate localization of the lesion is possible with this technique. It is very applicable for planning of surgery on skull base tumors. The surgical procedure for small and well-defined, intrinsic pathologic deep-seated brain lesions, however, becomes much easier by using the stereotactic techniques of this system. The target point and the direction brain-surface-to-lesion can be determined within seconds. Before the aiming probe is inserted to the target, the cortical motor area is mapped by direct electrical stimulation. The approach can be varied depending on the results of these neurophysiologic investigations of the brain surface. The dissection is made along the aiming probe up to the target point. Because of the fixation of the brain with the needle, a brain shifting due to the dissection as well as to CSF release is diminished. Forty patients with deep-seated intracerebral lesions were operated on during a 13 months period by these combined techniques in our service. Using this technique, we never made a negative exploration. In all but three patients, total removal of the mass lesion was achieved. Permanent neurological deficits were observed in two patients only. In our opinion, this combined imaging and neurophysiological technique is easy to perform, and of major benefit for the patients due to its accuracy and is preferable in comparison with other single computer localizer techniques without neurophysiological monitoring.     

Iscom (Immuno Stimulating Complex)-vaccine of equine influenza virus--transmission electron microscopic investigation and literature review]

Dental caries is the major cause of tooth loss in elderly individuals with physical and mental disabilities. The diagnosis of caries in elderly individuals is difficult due to a complicated oral environment compounded by the prevalence of physical and mental barriers to care. The restoration of tooth structure and the replacement of teeth lost due to caries result in considerable economic and biological cost to both individuals and society. Decisions to remineralize, restore, or extract teeth depend largely upon the extent of the structural damage caused by the infection. Teeth with small lesions can be remineralized with fluorides, whereas teeth with large lesions may be restored or extracted. Caries risk assessment based on the history of previous infection, salivary parameters, and ingestion of sugar can be used as a basis for placing a patient on a caries-preventive regimen. This paper discusses the pathophysiology of caries to explain the appropriate diagnosis, prevention, and treatment of dental caries in elderly individuals with chronic disabilities.     

Solitary hepatic lesions with a hypoechoic rim: value of color Doppler sonography

OBJECTIVE: A hypoechoic rim around a focal liver lesion as revealed by conventional sonography may be present in malignant liver lesions as well as in benign liver lesions. This study evaluated the potential of color Doppler sonography in differentiating various focal liver lesions with a hypoechoic rim. CONCLUSION: Color Doppler sonography may be helpful in distinguishing focal nodular hyperplasia (FNH) from other focal liver lesions. The characteristic finding of blood flow within the hypoechoic rim of FNH is most likely caused by small vessel abnormalities that have previously been described for FNH.     

Unusual fibro-osseous lesion of the spinal cord with positive staining for glial fibrillary acidic protein and radiological progression: a case report

A rare intradural lesion of the lumbar spine producing leg pain and minimal neurological deficits is described in a 48-year-old man. Previous reports of similar lesions have been described under the designation "fibro-osseous lesions" and "calcifying pseudoneoplasms." This is the first report of an unusual fibro-osseous lesion with an intradural spinal location as well as the first to show immunohistochemical positivity for glial fibrillary acidic protein (GFAP) within cellular components of this process and crystal formation suggestive of calcium pyrophosphate. This case also shows radiographic progression suggesting the possibility that this entity may be a form of low grade neoplasm.     

Experience with radio isotope myelography from neurosurgical aspects (author's transl)

Experience with Radio Isotope Myelography is reported here. 169Yb-DTPA as a tracer was intrathecally injected at lumbar region in twenty three patients with various spinal cord lesions. The first scanning is perfomed after comfirming by gamma-camera that the tracer reaches to the lesion, the second and the third scannings are done according to the ascending rate of the tracer. (I) Normal scintimyelogram (A) In normal case, the shape of the Radio Isotope Myelogram well corresponds the shape of anatomical subarachnoid space. (B) In normal adult cases, the tracer comes up to the cisterna magna in 20-25 minutes after the lumbar injection. Therefore, the scintimyelographic diagnosis should be made not only by the shape but also by the ascending rapidity of the tracer. (II) Abnormal scintimyelogram Abnormal scintimyelograms could be summarized as following three categories. (A) "Delay": It means delay of the ascending of the tracer. Besides, "Transient delay" found in a case of Arnord-Chiari's malformation was proposed. (B) "Partial block": It meas a defect at the level of the lesion. This "Partial block" were observed in cases of spinal cord angioma, cervical spondylosis and spinal cord tumor etc. (C) "Complete block": It means the stagnation of the tracer below the lesion. To sum up, Rario Isotope Myelography, especially in partial block, can more easily and more sensitively represent the maximum extent of the spinal cord lesion than other myelographic study or angiographic one. On the other hand, we can not qualitatively diagnose about the lesions by its indistinct border.     

Solitary, central neurofibroma of the mandible: a case report

A case of Solitary Central Neurofibroma in a 53 years old female is reported. This is an apparently single primary lesion, in which physical and Radiological examination failed to reveal other bony lesions or the stigmata of multiple neurofribomatosis.     

Retinal lesions in tuberous sclerosis

Retinal lesions in 116 patients with tuberous sclerosis included three types: the relatively flat, semitransparent, non-calcified tumors; the more commonly described nodular, calcified tumors; and a third lesion that possessed features of the other two. Other less definite pigmented and plaque-like lesions also were seen. The evolution of a relatively flat, noncalcified lesion into an elevated nodular, apparently calcified lesion during an interval of two decades was photographically recorded.     

Anatomy-guided linear atrial lesions for radiofrequency catheter ablation of atrial fibrillation

The surgical atrial maze procedure has provided proof that atrial fibrillation can be cured by performing atrial incisions based on anatomical and electrophysiological principles. Preliminary reports of attempts at radiofrequency catheter ablation of atrial fibrillation utilizing an anatomy-based "linear incision" method have shown the feasibility of the method. However, postprocedural atrial fibrillation recurrence has been common and in addition new, uniform tachycardias have developed in some patients. Both of these outcomes may be in part due to incomplete or inconsistent lesion deployment. This article details the use of the CARTO system for deploying anatomy guided linear atrial lesions for the purpose of curing atrial fibrillation. The procedure is comprised of three phases, which are discussed in detail: (1) baseline map; (2) lesion deployment and; (3) lesion assessment. Using a single standard ablation electrode, lesions can be deployed safely, and complete lesions can be confirmed. Paradigms for right and left atrial incisions are proposed.     

Rapid healing of endobronchial tuberculosis by local endoscopic injection of corticosteroids

We report a case in which two endobronchial tuberculous lesions were diagnosed by bronchoscopy. Under antituberculosis chemotherapy, one lesion was submucosally injected with corticosteroids. Twelve days later, this lesion had almost completely disappeared, whereas the other lesion had remained unchanged. The latter lesion was then injected with corticosteroids, which resulted, 14 days later, in complete healing. Six months later, there were no stenotic or other lesions. These observations suggest that local injection of corticosteroids in endobronchial tuberculous lesions induces a rapid and complete resolution of these lesions, and may prevent the development of bronchostenosis.     

A light microscopic study of odontoblastic and non-odontoblastic cells involved in tertiary dentinogenesis in well-defined cavitated carious lesions

This study examines cellular and microradiographic findings in thin, undemineralized sections of 46 cavitated lesions, that were clinically well-defined with respect to lesion activity and estimated lesion age at extraction time. The progressive stages of surface breakdown ranged from enamel cavitation to larger dentine exposures classified as closed and open lesion environments. Measurements of the following parameters were performed using computerized image processing software: (a) the cytoplasm:nucleus ratio of primary odontoblast cells; (b) the cell:dentinal tubule ratio; (c) the adjacent predentine area (mum2), and (d) the cytoplasm: nucleus ratio of non-odontoblastic cells, and secondary odontoblast-like cells, where estimation of these cell types were based on structural criteria. In active enamel cavitated lesions, reduced odontoblast-predentine regions and indistinct subodontoblastic regions were noted. During initial dentine exposures, non-odontoblastic cells along the pulp-dentinal interface were observed as well. The first indication of tertiary dentine was seen in old lesions with exposed dentine. The tertiary dentine appeared more atubular in the closed/active lesions than in the open/slow-progressing lesions. The involved odontoblastic cells in tubular tertiary dentine in small open/slow-progressing lesions were comparable to the primary odontoblast cells, however, new dentinal tubules were also noted presenting a mixture between reactionary and reparative dentinogenesis. In close/active lesions non-primary odontoblastic cells were aligning the atubular tertiary dentine, whereas well-defined signs of secondary odontoblast-like cells were first seen in larger open lesions, producing tubular tertiary dentine. In conclusion, a strong relationship between external lesion environments and corresponding different formations of tertiary dentine was noted in advanced cavitated lesions. It is additionally suggested that the stimulation of tubular tertiary dentine could be a closely related reaction when an active lesion complex changes into a slower progressing lesion environment.     

Diaschisis

Following acute, localized lesions of the central nervous system, arising from any cause, there are immediate depressions of neuronal synaptic functions in other areas of the central nervous system remote from the lesion. These remote effects result from deafferentation, a phenomenon known as "diaschisis". After an interval of time, which will vary directly with the severity of the lesion, functional recovery occurs due to synaptic reactivation of neurones. This is favourably influenced by rehabilitation. Diaschisis most commonly manifests itself by such neurological signs as impaired consciousness or cognitive impairments including dementia, dyspraxias, dystaxias, dysphasias, incoordination and sensory neglect. The nature of diaschisis has been demonstrated by widespread depressions of local cerebral blood flow and metabolism extending far beyond the anatomical lesion. Recovery of function is associated with recovery of local perfusion and metabolism.     

Differential expression patterns of GABA transporters (GAT1-3) in the rat olfactory bulb

OBJECTIVES: This report used intravascular ultrasound and quantitative coronary angiography to explore the relation between lesion-associated calcium and risk factors, clinical presentation and angiographic severity of coronary artery stenoses. BACKGROUND: Coronary artery calcium is a marker for significant coronary atherosclerosis. Noninvasive procedures are being proposed as screening tests for coronary artery disease. Intravascular ultrasound identification of tissue calcium has been validated in vitro. METHODS: Independent chart review, preintervention intravascular ultrasound imaging and coronary angiography were used to study primary native vessel lesions in 1,442 patients. Target lesions and reference segments were evaluated according to previously published quantitative and qualitative methods. Results are presented as mean value +/- SD. RESULTS: Overall, 1,043 lesions contained target lesion calcium (72%); the arc of target lesion calcium was 110 +/- 109 degrees. Lesions with an ultrasound plaque burden > 0.75 or an angiographic diameter stenosis > 0.25 had a prevalence of calcium of at least 65%, with a mean arc > 100 degrees. Intermediate lesions had as much target lesion calcium as did angiographically severe lesions. Using multivariate linear regression analysis, patient age, stable (vs. unstable) angina and the intravascular ultrasound lesion site and reference segment plaque burden (but not the angiographic diameter stenosis) were the independent predictors of the arc of target lesion calcium (all p < 0.0001). CONCLUSIONS: Intravascular ultrasound analysis shows that coronary calcification correlates with plaque burden but not with degree of lumen compromise. Thus, the noninvasive detection of coronary calcium is predictive of future cardiac events, presumably because coronary calcification is a marker for overall atherosclerotic plaque burden. Coronary calcium increases with increasing patient age and is less common in unstable lesion subsets.