Bilateral superior ophthalmic vein enlargement associated with diffuse cerebral swelling. Report of 11 cases

Bilateral superior ophthalmic vein (SOV) enlargement has rarely been shown to occur in patients with septic and aseptic cavernous sinus thrombosis, Graves' disease due to obstruction of the SOV by enlarged extraocular muscles, or carotid-cavernous fistulas caused by retrograde flow. The authors describe 11 patients with bilateral SOV enlargement associated with cerebral swelling as detected by computerized tomography scanning. The bilaterally enlarged SOVs returned to a normal size following resolution of cerebral swelling and elevated intracranial pressure. To the authors' knowledge, this is the first report of bilateral SOV enlargement associated with diffuse cerebral swelling that subsequently resolved after treatment of the cerebral edema. The authors believe that the bilateral SOV enlargement was caused by mechanical cavernous sinus venous stagnation due to cerebral swelling, a syndrome that occurs more commonly than currently appreciated.     

Idiopathic primary pulmonary hemosiderosis. Report of three cases (author's transl)]

Three cases of idiopathic primary pulmonary hemosiderosis are reported. Hemosiderin was demonstrated in macrophages (siderophages) in all three cases. In one of them, isotopic examination with radioiron and in an other one, a pulmonary biopsy were performed. All the patients received corticosteroids. The first case had a good evolution in spite of five years without therapy. The second case showed a bad therapeutic response and required immunosuppressive drugs. The third case with a short follow-up is doing well. Literature is reviewed, and considerations about etiopathogeny, clinical features, roentgenographic and therapeutic aspects of the disease are made.     

Felodipine use in pregnancy. Report of three cases

BACKGROUND: Calcium channel blockers are effective agents for the management of chronic hypertension and are being used with increasing frequency. If their safety and efficacy during pregnancy can be documented, women can be counseled to continue their antihypertensive agent during pregnancy. To our knowledge, the use of felodipine, a calcium channel blocker of the dihydropyridine group, during pregnancy has not been described. CASES: We report three cases of felodipine use in pregnancy by women with chronic hypertension. CONCLUSION: In women with severe hypertension (diastolic blood pressure > 100 mm Hg) who require pharmacologic treatment of it during pregnancy, felodipine appears to be an acceptable option.     

Persistent hypoglossal artery associated with aneurysms. Report of two cases

The approach to management of idiopathic thrombocytopenic purpura (ITP) during pregnancy remains controversial--particularly regarding the method of delivery. Regardless of the maternal platelet count, we believe that these patients should be delivered by elective cesarean section at term because of the continued presence of maternal antiplatelet IgG antibodies, which cross the placenta. Despite the method of treatment used to increase maternal platelets, immunologic factors are significnat for neonatal involvement and should be considered in the management of these patients. The single largest factor responsible for reported neonatal losses has been intracranial hemorrhage secondary to thrombocytopenia and birth injury. Two patients with ITP are presented with data to substantiate our position on the method of delivery. The infants were transiently thrombocytopenic following delivery (despite adequate maternal levels of platelets).     

Reconstructive surgery of the lower lip with esthetic-functional recovery: report of 2 cases]

OBJECTIVE: The objective of this study was to present the use of retrograde colon enema in myelodysplasic patients with fecal incontinence. PATIENTS AND METHODS: Thirty-three patients, 16 males and 19 females, 5 to 22 years old (average age 11.9 years) with spina bifida and fecal incontinence which obliged them to use a diaper. Retrograde colon enema procedures were performed in all of them. RESULTS: With the use of the retrograde enema the best rectal emptying was achieved and kept 32 children (97%) diaper free after a follow-up period of more than two years. Only one girl (3%) needed pads because she was not able to defecate in an appropriate place after administering the enema. CONCLUSIONS: The retrograde enema is the best conservative treatment for children with neurogenic fecal incontinence. This method achieves good rectal emptying allowing the children to be diaper free, resulting in better social adaptation and integration.     

Granulomas and cholestatic--hepatocellular injury associated with phenylbutazone. Report of two cases

A combined cholestatic-hepatocellular injury and noncaseating granulomas occurred in two patients 1 and 4 weeks after phenylbutazone therapy. Both patients were jaundiced, one had a macular rash, and both had peripheral blood eosinophilia. Symptoms and signs subsided, and abnormal findings from tests of hepatic function rapidly returned to normal following withdrawal of the drug. Sections of liver biopsy specimens 6 months later showed no granulomas or other pathologic changes. Previously reported cases are reviewed.     

Aplastic anemia associated with submassive hepatic necrosis. Report of four cases

Four cases of fatal aplastic anemia were associated with submassive hepatic necrosis. The subjects were males, ranging in age from 20 to 33 years. Pathogenesis remained obscure.     

Immunohistochemical evaluations of ultrashort-segment Hirschsprung's disease. Report of three cases

PURPOSE: Unlike classic Hirschsprung's disease, short-segment and ultrashort-segment varieties are usually found to be latent and milder. Ultrashort-segment Hirschsprung's disease may present as intractable chronic constipation in children over one year of age, adolescents, and adults. Anorectal myectomy has been shown in many instances to provide effective long-term treatment for certain patients with ultrashort-segment Hirschsprung's disease. Histologically, the affected segment in Hirschsprung's disease has been shown to have increased cholinergic nerves, lack of nitric oxide synthase-containing neuronal elements, and show moderate to severe loss of myenteric neurons. METHODS: Here, we report three cases that showed clinical and manometric evidence of ultrashort-segment Hirschsprung's disease. Two of the three patients responded well to myectomy. RESULTS: Detailed histologic and immunohistochemical evaluation of the internal anal sphincter and a comparison with three normal controls revealed absence of nitric oxide synthase-containing neurons in both cases that responded well to surgery and continued presence of these neurons in the patient who did not respond. A review of the current literature on various treatment modalities is included. CONCLUSIONS: Anorectal myectomy provides long-term relief of this chronic problem in a subgroup of patients with ultrashort-segment Hirschsprung's disease who lack nitrinergic neurons at the internal anal sphincter.     

Actual asymptomatic epidural hematomas in childhood. Report of three cases

It is well known that the mortality of epidural hematoma (EDH) cases is directly related to the patient's level of consciousness at the time of surgery. The authors report three actually asymptomatic patients with mild head injury, in whom the diagnosis of EDH was possible because of quite broad indications for computed tomographic (CT) scanning, which allowed diagnosis and treatment in an early phase. These cases illustrate the possibility of an EDH in a totally asymptomatic patient.     

Rhabdoid tumours of the central nervous system. Report of three cases with immunocytochemical and ultrastructural findings

Blood samples from malaria-infected patients and from in vitro culture were analyzed using the H*1 hematology analyzer. An attempt to find a hematologic parameter for detecting the malaria infection and to characterize the pathophysiological changes of red cells was made. The study included 18 malaria-infected patients (10 with Plasmodium falciparum and 8 with Plasmodium vivax) and 52 normal, healthy volunteers. Increased young large lymphocyte or large unstained cell count (LUC over 3%) in the peripheral blood of malaria-infected patients was evidence for malaria infection. Increased population dispersions of red cell volume (red cell distribution width: RDW) and intraerythrocytic hemoglobin concentration (hemoglobin distribution width: HDW) were demonstrated both in clinical samples and cultured blood. The increased RDW correlated with an increased percentage of macrocytes (r = 0.64, P = 0.004). Comparison of HDW and percentage of hypochromic red cells between the clinical specimen and the cultured blood supports the finding that changes in red cell hemoglobin concentration were mainly due to the response of the patient to malaria infection and partly due to the effect of malaria parasites on the red cells.     

Salter-Harris type III fracture of the medial femoral condyle associated with an anterior cruciate ligament tear. Report of three cases and review of the literature

Previous work has shown that stomatal opening induced by indole-3-acetic acid (IAA) in epidermal strips of the orchid Paphiopedilum tonsum L. is preceded by a reduction in cytoplasmic pH (pHi) of the guard cells. We now report that Fab fragments of an auxin-agonist antibody (D16), directed against a putative auxin-binding domain of the auxin-binding protein ABP1, induce stomatal opening and decrease guard-cell pHi, as monitored with the acetomethoxy ester of the ratiometric pH indicator Snarf-1. Similar activity was shown by a monoclonal antibody against the same domain. The C-terminal dodecapeptide, Pz152-163 of maize ABP1 (ABPzm1) induced guard-cell alkalinization and closed stomata, as did Fab fragments of a monoclonal antibody (MAC 256) recognising the C-terminal region of ABPzm1. By implicating, for the first time, an auxin-binding protein in mediation of an auxin-dependent physiological response, these findings strongly support an auxin-receptor role for ABP1.     

Reconstruction of the lower lip and chin with local flaps

We present a single patient with reconstruction of a rectangular defect of 40% of the lower lip and chin. The method used constitutes a modification of the Karapandzic method, with the addition of an advancement of the lateral cheek and remaining chin. The technique restores form, sensation, and function- the principles of a successful reconstruction.     

Delayed internal capsule infarctions following radiofrequency pallidotomy. Report of three cases

The authors report on a series of patients with idiopathic Parkinson's disease (IPD) who underwent stereotactic radiofrequency (RF) pallidotomies, three of whom suffered delayed postoperative strokes. These three belonged to a group consisting of 42 patients with medically intractable IPD in whom 50 pallidotomies were performed. All three patients had significant previous vascular disease and were in a high-risk group for cerebral infarction. A postoperative magnetic resonance (MR) image was obtained immediately after the pallidotomy was performed to document the placement of the RF lesion and to rule out any hematoma. The delayed strokes occurred on postoperative Days 10, 51, and 117 in patients with previous vascular disease (Group 1, 11 patients). No strokes occurred in the group with the vascular disease risk factor (Group 2, 11 patients) or in the group with no risk factors for vascular disease (Group 3, 20 patients). This observation is statistically significant (p < 0.05). The T2-weighted MR images showed the lesions as high-intensity signals extending to the posterior limb of the internal capsule ipsilateral to the pallidotomy site. The poststroke T1-weighted images obtained in two patients showed persistent contrast enhancement of the RF lesion and no enhancement around the stroke lesion. Clinically and radiographically, these discrete new lesions represent delayed infarctions, suggesting that RF lesioning can induce delayed injury in adjacent tissue. Patients with previously identified vasculopathy may be at risk for delayed capsular infarction following RF pallidotomy.     

Syringomyelia following lumboureteral shunting for communicating hydrocephalus. Report of three cases

Three patients are described in whom syringomyelia was identified long after the treatment of communicating hydrocephalus by a lumboureteral shunt. The reason for syrinx formation in these cases could not be determined. In two there was either autopsy-proven or presumed evidence for arachnoiditis, and in the third patient the symptoms of syringomyelia were acutely aggravated by temporary obstruction of shunt. The development of a pressure drop from the intracranial compartment to the spinal compartment with crowding at the foramen magnum is also a suggested mechanism.     

Common benign lesions of the lower lip

Four cases of human parvovirus infection in which the main clinical manifestation was a polyarthritis are described. Four females with ages ranging from 30 to 32 years presented with acute symmetrical polyarthralgias involving hands and knees. In addition, evidence of synovitis in the ankles and tenosynovitis of the fingers was found in two and three cases respectively. Half of the patients noticed an erythematous rash in the preceding days. Laboratory studies were normal in all cases. Antinuclear antibodies and rheumatoid factor were not detected in any case. All patients had significant levels of IgG and IgM antibodies to parvovirus B19 at the time of presentation and a rise in IgG and a fall in IgM levels were seen at two months. All cases cleared up within two weeks without treatment.     

Progressive intracranial occlusive disease associated with deficiency of protein S. Report of two cases

BACKGROUND AND PURPOSE: Deficiency of the free fraction of protein S has been associated with arterial or venous stroke. The pathogenesis of vascular occlusion in patients with protein S deficiency is not known. We present two cases of cerebral infarction and deficiency of protein S in which the subjects had progressive intracranial occlusions. CASE DESCRIPTION: A 16-year-old girl was admitted because of left brain stem infarction and protein S deficiency. Cerebral angiography disclosed stenosis of the right intracranial vertebral artery and occlusion of the left posterior cerebral artery. A second angiogram performed 18 months later disclosed occlusion of the right vertebral intracranial artery. In the second case, a 17-year-old girl was admitted because of left hemispheric cerebral infarction and protein S deficiency. Cerebral angiography showed stenosis of the left anterior cerebral artery, left supraclinoid internal artery, and left middle cerebral artery. A second cerebral angiogram performed 5 months later disclosed occlusion of the left anterior cerebral artery and poor hemispheric perfusion through the left middle cerebral artery. CONCLUSIONS: Based on our cases, we postulate that some patients with prothrombotic states may develop progressive intracranial arterial occlusions, possibly secondary to a permanent thrombogenic stimulus. We suggest routinely searching for prothrombotic states in young patients with intracranial occlusion, especially if the occlusion is progressive and other causes are not obvious.     

Acute hemiplegia in children complicating upper respiratory infections. Report of three cases with angiographic findings

Three children presented with acute onset of hemiplegia following an upper respiratory infection. Angiography revealed irregulaities, beading, and slow flow of a peripheral branch of a middle cerebral artery. In addition, one child had narrowing of the cervical segment of the internal carotid artery. An inflammatory arteritis of the cervical internal carotid artery is presumably the site of the formation of cerebral emboli.