Reactive airways dysfunction syndrome: two case reports

The antimicrobial susceptibilities of 1058 Staphylococcus aureus and 2,163 coagulase-negative staphylococci (CNS) isolates obtained from clinical specimen between 1988 and 1995, were determined against 13 anti-staphylococcal antibiotics. During the study period the resistance of Staphylococcus aureus to ciprofloxacin, ceftazidime, and norfloxacin increased significantly by 7%, 4%, and 6%, respectively (p < or = 0.001). By comparison, the antibiotic resistance of CNS to ceftazidime, oxacillin, norfloxacin, ciprofloxacin, fusidic acid, and cefoxitin increased by 20%, 17%, 15%, 14%, 12% and 10%, respectively (p < or = 0.001). Invasive and noninvasive S. aureus had similar antibiotic resistance, whereas CNS invasive isolates were more resistant than noninvasive isolates to every antibiotics, except vancomycin and fusidic acid. These differences were significant (p < 0.001) for oxacillin, cefoxitin, and clindamycin. Our observations confirm that staphylococci and particularly CNS isolates show an important rate of increased resistance to the standard antimicrobials used for therapy, and that the rate of emergence of resistance differ considerably between coagulase-positive and coagulase-negative staphylococci.     

Correcting high anisometropia: two case reports

In the cases reported, the anisometropia had not been corrected previously. Despite the common belief that such a correction would induce intolerable symptoms in adults, both patients successfully adapted to the full correction within a few days, showing marked improvement in binocular vision skills.     

Upper esophageal stenosis: two case reports

Esophageal stenosis caused by an intrinsic congenital deformity is uncommon in infants and children. The main forms of stenosis are congenital esophageal web congenital stricture caused by tracheobronchial remnants, and congenital idiopathic muscular hypertrophy. The authors report on two patients who were successfully treated and managed after being diagnosed as having upper esophageal stenosis. One patient underwent resection of the web and primary anastomosis of the esophagus and was discharged 6 days after surgery. After 1 year, this patient has had no symptoms of dysphagia or other postoperative difficulties. The second patient underwent balloon dilatation of the esophageal stricture and was discharged on the day of surgery; however, this patient required numerous repeat dilatations.     

Gastric metastases of melanoma: two case reports

Primary hydatid cyst of the brain in adults is rare and can pose various diagnostic problems. Multiplicity of these cysts is even rarer. The most important diagnostic tool is computed tomography scanning of the brain. Hydatid cyst should be included in the differential diagnosis when a cystic brain lesion is found in patients from an endemic echinococcosis area.     

Non-atherosclerotic coronary artery aneurysms: two case reports

Non-atherosclerotic isolated coronary artery aneurysm is not common. Two cases of non-atherosclerotic isolated coronary artery aneurysm, with similar presentations but different management strategies were presented. The patients were well four and six years later, respectively. The definition, incidence, causes, presentation, complications, investigations, management, and prognosis of coronary artery aneurysms are discussed. The difficulties of determining pathogenesis and different management strategies are highlighted. An isolated coronary artery aneurysm should be managed on its merits.     

Isolated superior gluteal nerve injury: two case reports

Isolated superior gluteal nerve injury has been infrequently described in the literature, mainly from injections or hip surgery. Its course through the greater sciatic foramen renders it at risk in pelvic or hip trauma. We report 2 cases of electromyographically documented isolated superior gluteal nerve injury following pelvic trauma. These cases illustrate that weakness in hip abduction following pelvic trauma may indicate the presence of a superior gluteal nerve injury, warranting further clinical and electrodiagnostic evaluation.     

Large benign pineal cysts: two case reports with review

Skin biopsies at the plaque regions and adjacent skin obtained from HIV-infected 22-40-year-old patients with Kaposi's sarcoma have been analyzed. Morphological changes revealed depended on the stage of the disease and cell specificity. The alterations were as follows: cell adenoma with degeneration and destruction of cell organelles, changes of the specific granules and microfilaments. Langerhans cells appeared to be most susceptible to HIV and showed all types of changes. In the course of the disease gradual decrease of the activity of the main metabolic enzyme - adenylate cyclase - was recorded.     

Foreign-body abscesses presenting as soft-tissue tumours: two case reports

Green function analysis of the Fokker-Planck equation was used to describe protein conformational motion for approximate variational derivation of typical rate constant of protein relaxation from excited nonequilibrium state to the equilibrium. This approach was illustrated on a simple one-dimensional conformational potential.     

Gorham's disease: a literature review and case reports

Gorham's disease (disappearing bone disease, massive osteolysis, idiopathic osteolysis, essential osteolysis, progressive atrophy of bone, spontaneous absorption of bone, phantom bone, hemangiomatosis/lymphangiomatosis of bone, progressive osteolysis) is an extremely rare occurrence. There are fewer than 150 reported cases in the literature. This disorder can be characterized by spontaneous or posttraumatic progressive resorption of bone. The etiology is still very speculative, the prognosis unpredictable, and any effective therapy still unknown. This paper presents a review of the literature and two case reports of suspected Gorham's disease of the bones of the foot.     

Successful removal of large pineal region meningiomas: two case reports

BACKGROUND: Pineal region meningiomas are extremely rare tumors and comprise about 8% of tumors of this region. Two cases of large pineal region meningiomas in young males are presented. METHODS: Computed tomography (CT) scan and cerebral angiography were used to evaluate the patients preoperatively. Both patients were operated on through an occipital transtentorial approach either as a single- or two-stage procedure. RESULTS: Preoperative work-up revealed that both tumors received their main blood supply from the posterior lateral choroidal arteries and were therefore originating from the velum interpositum cerebri (superior tela choroidea). Complete tumor removal was effected in the first patient using a right occipital transtentorial approach. In the second patient, after partial removal using the same approach, complete resection was achieved at a second stage via the left occipital transtentorial approach 3 months later. CONCLUSION: Cerebral angiography, which must include vertebral angiography, is important in the preoperative surgical planning of these tumors. The occipital transtentorial approach provides good access. However, a two-stage procedure using right and left sides may be necessary for large meningiomas receiving a bilateral blood supply from both posterior lateral choroidal arteries. Diagnosis, the surgical approach, and methods of tumor excision are discussed.     

Successful pregnancies in the presence of spinal muscular atrophy: two case reports

We report two cases of successful pregnancy in women with chronic, infantile onset, or type II spinal muscular atrophy, both of whom delivered healthy, unaffected babies. The patients required concurrent management by a physiatrist, pulmonologist, and perinatologist throughout the pregnancy. Complications included recurrent urinary tract infections, dyspnea and worsening of pulmonary function, wheelchair seating and positioning problems, and musculoskeletal and low back pain. These problems resolved postpartum. One woman had vaginal delivery, the other had caesarean section, both of which were well-tolerated. Because of severe musculoskeletal deformity, pelvic assessment is necessary to determine the mode of delivery. The uterus has normal contractility and effective labor patterns can be established. Spinal/epidural anesthesia may be contraindicated because of spine deformity. The pregnancies had no deleterious effect on the progression of the disease in our patients, both of whom reported a positive experience with great personal fulfillment.     

Manipulation under epidural anesthesia with corticosteroid injection: two case reports

OBJECTIVE: To discuss the combined use of selective epidural steroid injection (ESI) and spinal manipulative therapy (SMT) in treating recalcitrant lumbar radiculopathy. CLINICAL FEATURES: In a first case, a patient suffered from numbness and pain in an S1 dermatome distribution 6 months after undergoing lumbar discectomy. Clinical correlation with advanced imaging led to the diagnosis of L5 intervertebral disc (IVD) syndrome with peridural scar formation. In a second case, a patient suffered from low-back and right-leg pain of 9 months' duration. Various forms of conservative treatment were not effective. A diagnosis of L4 IVD syndrome with radiculopathy was made. INTERVENTION AND OUTCOME: The first patient received conventional treatments, including physical therapy, SMT, fluoroscopically guided ESI and oral medications, with consistent but short-lived response. A team consisting of an anesthesiologist (dedicated spinal injectionist) and chiropractor performed manipulation under epidural anesthesia (MUEA) with corticosteroid injection. Follow-up at 60 days showed marked improvement in visual analogue scale, pain drawing and Oswestry pain and disability index. The second patient received all of the same conventional care except ESI before the combined procedure. The patient underwent MUEA, followed up with eight sessions of stretching and manipulation over the ensuing 3 wk. At 45 days after the combined procedure, the patient had a negative SLR (previously positive at 70 degrees), no leg pain and a marked reduction in back pain. CONCLUSION: This article discusses an integrated procedure that combines two standard treatments that may act synergistically. Our positive results are consistent with other reports, both published and anecdotal. The technique of MUEA warrants further investigation by the health care industry.     

Permanent paraplegia following epidural and general anesthesia: two case reports

Two strains of rats, Sprague-Dawley and Wistar, were assayed in order to determine which strain is the more suitable experimental model for the study of pharmacokinetic alterations induced by spinal cord injury. Animals were submitted to spinal cord contusion at the T8-T9 level by the weight drop method. A single acetaminophen oral dose (100 mg/ kg) was administered 24 h after injury and blood samples were drawn for a period of 4 h. Acetaminophen concentration in whole blood was determined by high performance liquid chromatography and pharmacokinetic parameters were estimated. For both strains, Cmax and AUC were significantly lower, whereas tmax remained unchanged, in injured animals compared to sham-injured controls. Circulating acetaminophen concentrations were higher; therefore, pharmacokinetic alterations were more easily discerned, in Sprague-Dawley than in Wistar rats. It is concluded that the Sprague-Dawley strain is a more suitable model for the study of pharmacokinetic alterations induced by spinal cord injury.     

Diverse presentation of aberrant origin of the right subclavian artery: two case reports

Aberrant origin of the right subclavian artery occurs in up to 1% of the population and can result in a wide range of symptoms. In this report, two cases of this anomaly are presented. In the first case, a patient developed fatal group A streptococcal aortitis. In the second case, the patient complained of chronic cough and intermittent dyspnea. The embryologic genesis of this abnormality is discussed and the current literature is summarized. Although relatively uncommon, it is important to consider this vascular anomaly in the differential diagnosis of patients with dysphagia, dyspnea, chest pain, fever, or mediastinal widening evidenced on chest roentgenography.     

Anterior sacral meningocele: two case reports and discussion of surgical approach

The kinetic properties of the N-hydroxylation of 2-acetylaminofluorene (2-AAF) are studied with microsomal preparations of livers from both control and 3-methylcholanthrene (3-MC)-pretreated rats and hamsters. The level of basal enzymatic activity is higher in hamster than in rat liver; 3-MC induces the activity in both animals. When added in vitro to incubation mixture, 3-MC competitively inhibits the N-hydroxylase activity. When fed to rats simultaneously with 2-AAF, 3-MC suppresses the carcinogenicity of the acetylated arylamine by inhibiting the first step in its activation pathway. Hamster tissues are not protected by this pretreatment because the level of N-hydroxylase activity is too high.