Primary diffuse leptomeningeal gliomatosis. Presentation of one case

A twenty-four-year-old woman presented with asthenia, anorexia and weight los associated with headache, neck ache, lumbo-sacral pain, flaccid quadriparous, bilaterally diminished vision and sphincter disorders. On computerized axial tomography of the skull, only slight signs of ventricular dilatation were seen. Cytochemical study of the cerebro-spinal fluid showed a marked increase in protein and there was a raised erythrocyte sedimentation rate. The patient was treated with steroids in view of the possibility of vasculitis or a demyelinating disorder. However the disease worsened and she died four months after onset of the disorder. Neuro-pathological study showed tumour infiltration of the leptomeninges of the base of both cerebral hemispheres, cerebellum and spinal medulla. The optic nerves, chiasma and spinal nerve roots were also infiltrated with neoplastic cells. No intraparenchymatous tumour was found. The neuropathological findings were compatible with primary diffuse leptomeningeal gliomatosis.     

Lower gastrointestinal bleeding as the initial presenting symptom of renal cell carcinoma

Renal cell carcinoma is known as one of the "great mimics encountered in clinical medicine," along with syphilis and tuberculosis. It can present clinically as a wide range of symptoms, with a classic triad described as hematuria, pain, and a palpable abdominal mass. However, this triad is present only in <20% of patients with renal cell carcinoma. Gastrointestinal bleeding has been described in renal cell carcinoma, although mainly secondary to metastasis in the upper gastrointestinal tract, with few cases due to local invasion. Lower gastrointestinal bleeding as a presenting symptom of an invasive primary renal cell carcinoma has been described in only one patient in the literature. Our patient is the first in whom a colonoscopic biopsy was used as a successful diagnostic modality.     

Primary respiratory failure as the presenting symptom in Lambert-Eaton myasthenic syndrome

Myasthenia gravis can present with rapid respiratory failure as the first manifestation of disease. In the Lambert-Eaton myasthenic syndrome (LEMS), such a manifestation has rarely been reported. We are reporting a patient who developed respiratory failure as the first manifestation of LEMS without associated carcinoma.     

Primary spinal T-cell rich B-cell lymphoma: a case report

During my nursing career, I remember constantly being aware of patients who needed some emotional help--those who were frightened about a forthcoming operation, those who were shocked and despairing after being given their diagnosis and prognosis, others who were down in the dumps because they couldn't go home as soon as they had hoped. There were also the 'ward clowns' who tried to make everyone laugh with their good humour and little pranks, yet felt no less anxious, worried or depressed than anyone else. Patients seem to fit into categories: the nervous ones, the depressives, the jovial types, the moaners, those who demand attention and those who shun it. I feel sure that every nurse has noticed the different 'types' of people who fill hospital beds-ordinary people who seem to take on a new persona as soon as they get into their pyjamas and become a 'patient'. Somehow, their identity gets folded up and put away in their locker along with their outdoor clothes and other reminders of the outside world.     

Osteomyelitis presenting as genital sore: a case report

A female attending the skin outpatient department presented with a genital sore which was treated as chancroid. On further investigation it proved to be the opening of a sinus secondary to chronic osteomyelitis of the pubic symphysis.     

Meckel''s diverticulum presenting as gastric outlet obstruction: case report

We report a case of gastric outlet obstruction simulating gastric antral neoplasm resulting from a perforated Meckel's diverticulum. Presentation of this nature has not been previously reported.     

Acute leukemia presenting as pericardial effusion--a case report

We report a patient with acute lymphoblastic leukemia, who presented with pericardial effusion. There was no haematologic evidence of leukemia at the time of presentation. The pericardial effusion resolved with chemotherapy. Although a common finding at autopsy, clinically evident pericardial effusion is rare in leukemia. It is also extremely rare for pericardial effusion to be the presenting feature or to antedate haematologic evidence of leukemia. Physician awareness is important to make a correct diagnosis.     

Sinonasal lymphoma presenting as a lethal midline granuloma: case report

Escherichia coli cells engineered to express an Hg2+ transport system and metallothionein accumulated Hg2+ effectively over a concentration range of 0.2-4 mg/L in batch systems. Bioaccumulation was selective against other metal ions and resistant to changes in ambient conditions such as pH, ionic strength, and the presence of common metal chelators or complexing agents (Chen, S.-L.; Wilson, D. B. Appl. Environ. Microbiol. 1997, 63, 2442-2445; Biodegradation 1997, 8, 97-103). Here we report the characterization of the bioaccumulation system based on its kinetics and an isotherm. Bioaccumulation was rapid and followed Michaelis-Menten kinetics. A hollow fiber bioreactor was constructed to retain the genetically engineered cells. The bioreactor was capable of removing and recovering Hg2+ effectively at low concentrations, reducing a 2 mg/L solution to about 5 microgram/L. A mathematical equation that quantitatively described Hg2+ removal by the bioreactor provides a basis for the optimization and extrapolation of the bioreactor. The genetically engineered E. colicells and the bioreactor system have excellent properties for bioremediation of Hg2+-contaminated environments.     

Right atrial myxoma presenting as nonresolving pulmonary emboli: case report

A case of right atrial myxoma causing extensive pulmonary embolization is described. Five years elapsed between the initial consultation and the correct diagnosis. The patient has been free of symptoms for 3 years following surgical removal of the tumor. The clinical manifestations of right atrial myxoma, the differential diagnosis, and the atypical lung-scan features are discussed.     

Mycoplasma pneumoniae infection presenting as Stevens-Johnson syndrome: a case report

A case of Mycoplasma pneumoniae infection as a precipitating factor in Stevens-Johnson Syndrome is presented. As the dentist may well be the first to see this syndrome, it is appropriate to highlight the condition and this particular organism as an infective cause.     

Hyperhidrosis as the presenting symptom in post-traumatic syringomyelia

Post-traumatic syringomyelia is now a well known entity and occurs months or years after a spinal cord injury. The presenting symptoms are usually pain, progressive motor weakness, sensory changes, and increased spasticity. Profuse sweating or hyperhidrosis can be a symptom of the post-traumatic syrinx or can occur in autonomic dysreflexia provoked by peripheral stimuli. We present two patients with cervical spine fractures whose presenting symptom of post-traumatic syringomyelia was hyperhidrosis affected by posture. The pathophysiology involved and the management of these patients is discussed.     

Radionecrosis of the brain presenting as a mass lesion: a case report

A case of radionecrosis of the brain in a patient previously treated for squamous cell carcinoma of the scalp is presented. Cerebral angiography revealed a mass effect primarily in the right frontal area. Computed tomography showed extensive hemispheric oedema. A frontal lobectomy was performed, and the recovery was excellent. The lower limit for brain tolerance for irradiation is about 5000 rads given in five weeks. This dose should not be exceeded when extracranial lesions are treated. Although computed tomography cannot diagnose brain necrosis, specifically, it should, along with the clinical history, be very helpful.     

Constrictive pericarditis presenting as unexplained recurrent pleural effusion: a case report

We describe herein the case of a patient who presented with total occlusion of all the major arteries in the unilateral iliofemoral region, including the distal deep femoral artery, on whom an aortolateral circumflex femoral-popliteal artery sequential bypass was successfully performed. This case report serves to demonstrate that the lateral circumflex femoral artery can provide a suitable midway outflow for aortopopliteal bypass in patients with extensive thrombosis of the iliofemoral arteries.     

Ganglioneuroma of the thoracic spine presenting as adolescent idiopathic scoliosis: a case report

Total coumarins of Fructus Cnidii (TCFC), 5 g.kg-1 by intragastric gavage, 6 d/wk, x 7 wk, was effective for prevention of bone loss in ovariectomized (OVX) rats. In comparison to aging control rats, the proximal tibia of placebo-treated OVX rats were characterized by an increase in eroded perimeter (+298%), label perimeter (+77%), osteoid perimeter (+47%), mineral apposition rate (+32%) and bone formation rate (+130%). These changes indicated a high bone turnover in OVX rats leading to a rapid bone loss (-44%) in proximal tibial metaphysis. In contrast, the TCFC-treated OVX rats showed an increase of cancellous bone area (+41%) compared with placebo-treated OVX rats and decrease in all the above indices of bone turnover to near aging control levels except that of the osteoid area (+88%) which was higher than that in aging control, but mineralization lag time did not show significant changes. The results suggested that the TCFC inhibited the high bone turnover and reversed the bone loss at early menopausal stage.     

Infantile spasms as the initial symptom of biotinidase deficiency

Two patients with biotinidase deficiency had diagnoses of infantile spasms made at 1 month of age. Biotinidase deficiency may be seen early in the neonatal period without the characteristic findings such as alopecia and seborrheic dermatitis. This diagnosis should be considered in patients with infantile spasms.     

Decompression sickness presenting as forearm swelling and peripheral neuropathy: a case report

Bleeding stomal varices is a rare complication of portal hypertension. We report the case of a cirrhotic patient, with a history of colonic adenocarcinoma, who had recurrent bleeding stomal varices. Treatment with transjugular intrahepatic portosystemic shunt and stomal varice embolization was performed because failure of medical treatment of portal hypertension and sclerotherapy. Twenty six months later only one stomal hemorrhage was noted. This suggests that transjugular intrahepatic portosystemic shunt and stomal varice embolization is effective in case of recurrent bleeding of stomal varices.     

HIV myelopathy as the presenting symptom of acquired immunodeficiency syndrome

INTRODUCTION: Spinal lesions in the acquired immunodeficiency syndrome (AIDS) occur in 22% of all neurological complications, although their occurrence as the first sign of the disease is very uncommon. First place amongst the myelopathies described as associated with HIV is taken by vacuolar myelopathy, followed by the myelites. CLINICAL CASE: We studied a 65 year old homosexual man who had previously been free of symptoms and signs of HIV infection. He was seen for progressive paraparesia which had begun some days previously, followed by altered sense of position and of vibration. Complementary tests showed that the patient was a carrier of HIV antibodies in high titre (P-24) with a high viral load of 907 x 1,000 copies RNA/ml. Testing with evoked potentials showed changes compatible with involvement of the sensory pathways of the spinal cord. After treatment with dexamethasone there was obvious improvement with partial recovery of his symptoms. CONCLUSIONS: The neurological condition described was compatible with vacuolar type myelopathy due to HIV, appearing in the initial stages of the illness and coinciding with a marked increase in the viraemia. Although necropsy is necessary for confirmation of the diagnosis, more and more evidence is being found on which to base clinical suspicion. We discuss various hypotheses regarding possible pathogenic mechanisms arising in these circumstances.