Amebic encephalitis caused by Balamuthia mandrillaris in a Czech child: description of the first case from Europe

Lower leg ischemia associated with aortic dissection is a potentially life-threatening condition requiring immediate treatment. To better understand the diagnostic factors and improve the treatment strategy of this serious complication, we analyzed our experience regarding the radiographic findings, treatment, and outcome in eight patients (aged 28-72 years, six men and two women). CT revealed type A aortic dissection in seven patients and type B in one. The obstructed site was in the iliac artery in five patients and in the abdominal aorta below the renal arteries in three. Surgical procedures included five ascending aortic graft replacements, three femoro-femoral bypasses, and one each of surgical fenestration, aorto-iliac bypass, and axillo-femoral bypass with thrombectomy. Endovascular treatment was performed in two patients, iliac stent placement in one, and thrombolysis of the iliac artery in one. Five patients survived and three died due to myonephrotic metabolic syndrome in two and postoperative bleeding in one. Treatment strategy depends on several issues regarding aortic dissection including ascending aortic involvement, patent false lumen, entry site, renal artery involvement, and thrombosis in a true or false lumen. CT and angiography are the most important methods for deciding upon appropriate therapy in each individual.     

Granulomatous amebic encephalitis due to Balamuthia mandrillaris (Leptomyxiidae): report of four cases from Mexico

OBJECTIVE: The influence of psychogenic factors on voiding generally manifests as an irritative syndrome and rarely in the form of acute or chronic urinary retention. The diagnosis and treatment of this uncommon urological pathology are reviewed and our experience is presented. METHODS: We conducted a retrospective study on 5 patients with psychogenic urinary retention (3 males and 2 females), aged 20 to 28 years (mean age 23.4), that had been treated at our urological services over the last 6 years. Three patients (2 males and 1 female) had a history of depression, one patient had a somatic form of disorder (mimicking) and one patient was diagnosed as having schizophrenia one year after he had presented with urinary retention. The physical and neurological examinations were normal in all 5 patients and the radiological evaluation was normal in all but one patient who had bilateral hydronephrosis. The pressure/flow test disclosed absence of detrusor muscle contraction in all 5 patients; 3 had incomplete voiding by abdominal pressure and had more than 500 ml residual urine. All patients received psychiatric therapy, and intermittent catheterization and urinary rehabilitation until residual urine less than 100 ml was achieved. CONCLUSIONS: The importance of the urodynamic study in the diagnosis of this condition is underscored. Definitive diagnosis can only be established after discarding other pathologies. The initial treatment must always be conservative; irreversible surgical procedures must not be performed. Treatment is by intermittent catheterization, urinary rehabilitation and supportive psychiatric therapy.     

Chorea caused by lithium intoxication: a case report and literature review

We report a patient who developed an acute, reversible, generalized choreiform disorder from lithium (Li) intoxication. This medication was prescribed for manic-depressive disorder, and serum levels became elevated after the addition of a diuretic for the treatment of hypertension. There were no other apparent causes for the movement disorder, and it was associated with other known features of Li intoxication, including ataxia and encephalopathy. There was a delay between the initial symptoms of Li intoxication and the onset of chorea. The chorea improved as serum Li levels diminished, with some lag time. This represents the eleventh case report of Li-induced chorea, but only the sixth in a patient without concomitant neuroleptic therapy, and the first presented with videotape confirmation. A review of these other cases is included, and possible mechanisms are discussed.     

Trypanosoma cruzi meningoencephalitis in AIDS mimicking cerebral metastases: case report

BACKGROUND: It has been suggested that citrate salts might enhance aluminum (Al) absorption from a normal diet, posing a threat of Al toxicity even in subjects with normal renal function. We have recently reported that in normal subjects and patients with moderate renal failure, short-term treatment with tricalcium dicitrate (Ca3Cit2) does not significantly change urinary and serum Al levels. However, we have not assessed total body Al stores in patients on long-term citrate treatment. OBJECTIVE: The objective of this study was to ascertain body content of Al non-invasively using the increment in serum and urinary Al following the intravenous administration of deferoxamine (DFO) in patients with kidney stones and osteoporotic women undergoing long-term treatment with potassium citrate (K3Cit) or Ca3Cit2, respectively. METHODS: Ten patients with calcium nephrolithiasis and five with osteoporosis who were maintained on potassium citrate (40 mEq/day or more) or calcium citrate 800 mg calcium/day (40 mEq citrate) for 2 to 8 years, respectively, and 16 normal volunteers without a history of regular aluminum-containing antacid use participated in the study. All participants completed the 8 days of study, during which they were maintained on their regular home diet. Urinary Al excretion was measured during a two-day baseline before (Days 5, 6) and for 1 day (Day 7) immediately following a single intravenous dose of DFO (40 mg/kg). Blood for Al was obtained before DFO administration, and at 2, 5 and 24 hours following the start of the infusion. RESULTS: The median 24-hour urinary Al excretion (microgram/day) at baseline versus post-DFO value was 15.9 vs. 44.4 in the normal subjects and 13.3 vs. 35.7 in the patients. These values were all within normal limits and did not change significantly following DFO infusion (p = 0.003 and p = 0.0001, respectively). The median change of 17.1 micrograms/day in urinary Al in the normal subjects was not significantly different from the 18.7 micrograms/day change measured in the patient group (p = 0.30). Similarly, no change in the mean serum Al was detected at any time following the DFO infusion, either in the patient or control group (patients 4.1 to 4.3 ng/ml, controls 7.4 to 4.6 ng/ml). CONCLUSION: The results suggest that abnormal total body retention of Al does not occur during long-term citrate treatment in patients with functioning kidneys.     

Hypoproteinemia caused by tricuspid regurgitation: report of a case

A case of tricuspid regurgitation (TR) complicated by severe hypoproteinemia is presented herein. A 68-year-old man who had undergone coronary artery bypass grafting (CABG) for postinfarction angina suffered repeated inferior myocardial infarction due to obstruction of the proximal right coronary artery, 3 years after which he developed systemic edema. Investigations revealed TR associated with hypoproteinemia; however, treatment consisting of aggressive diuretic therapy and albumin administration proved ineffective. The hypoproteinemia manifested as protein-losing enteropathy clinically, and the tricuspid valve was replaced to eliminate high venous pressure. The serum protein levels became normalized after the operation. Although TR is generally well tolerated in the absence of pulmonary hypertension, surgical management is recommended for patients with severe protein deficiency resistant to medical treatment.     

Asphyxial death caused by a laryngeal schwannoma: a case report

Neurogenic tumours of the larynx are unusual, with approximately 115 cases reported in the literature to date. Most of these lesions are benign, solitary submucosal nodules which present with hoarseness and are amenable to surgical resection. We present a case of a large pedunculated schwannoma arising in the aryepiglottic fold associated with sudden asphyxial death in an otherwise healthy young female.     

MURCS association: case report and review

We report on a 25 year old woman with aplasia of the Müllerian duct, unilateral renal agenesis, and anomalies of the cervicothoracic somites (MURCS association). Growth retardation and facial asymmetry were also present. A review of published reports allows MURCS association to be distinguished from related associations, sequences, and syndromes. Moreover, sporadic occurrence, the broad spectrum of associated anomalies, and the involvement of different organ systems closely related in early embryogenesis are arguments for considering MURCS association as the consequence of a developmental field defect.     

Streptococcal pyomyositis: case report and review

Pyomyositis is most often associated with Staphylococcus aureus infections after trauma. We describe an unusual presentation of pyomyositis of the chest wall secondary to group A betahemolytic streptococcus infection in a 15-month-old child with acute abdominal symptoms. In addition, the patient had no history or evidence of trauma to the affected area. Pyomyositis presenting in this manner secondary to group A beta-hemolytic streptococcus infection in the absence of a primary varicella infection has not been previously reported.     

Granulomatous hypophysitis caused by a ruptured intrasellar Rathke''s cleft cyst: report of a case and review of the literature

STUDY OBJECTIVES: To determine the clinical significance of Candida sp isolated from bronchoscopic samples in patients with suspected pneumonia. DESIGN: A retrospective chart review was performed in all nonneutropenic adult patients with Candida sp isolates from respiratory secretions obtained by bronchoscopy over a 5-year period (1991 to 1995). Potential risk factors, therapeutic decisions, and outcome were recorded. Microbiological findings, chest radiograph reports, and pathologic material were reviewed. Isolates were classified as definite, probable, or indeterminate contamination, or as definite pulmonary candidiasis, on the basis of histologic findings, therapeutic decisions, and outcome. SETTING: A 600-bed teaching hospital with 16 beds in a medical-surgical ICU. PATIENTS: Thirty-seven consecutive patients with positive cultures for Candida sp from respiratory samples obtained by bronchoscopy were evaluated. Thirty-two of these 37 patients (86.5%) received antibiotic therapy prior to sampling, and 23 (62.2%) were intubated. RESULTS: Contamination was classified as definite in 3 patients (8.1%) and probable in 30 others (81.0%). Contamination was indeterminate in two cases (5.4%). Two additional patients (5.4%) received antifungal agents for systemic candidiasis. No cases of pulmonary candidiasis could be demonstrated, although 24 of 28 patients showed protected specimen brush cultures > or = 10(3) cfu/mL. CONCLUSIONS: Nonneutropenic patients with isolation of Candida sp from bronchoscopic samples, even in high concentrations, are unlikely to have invasive candidiasis. Indication for initiation of antifungal therapy should be based on histologic evidence or identification from sterile specimens.     

Intussusception caused by a carcinoma of the cecum during pregnancy: report of a case and review of the literature

Respiratory infections are the most common infection in children. They differ remarkably according to age, bacteria and viruses. Therefore a careful history of outbreak, age, former infections, involvement of surroundings, symptoms, etc are essential. The present study included 50 children, aged between 0.3 and 12 yrs, all treated ambulatorily. 21 received brodimoprim (B) and 29 erythromycin (E). Indications were: tonsillitis, bronchitis, otitis media, sinusitis and scarlet fever. Dosages were: B was given 10 mg/kg body weight (b.w.) initially followed by 5 mg/kg b.w., once-a-day. The duration of treatment varied between 4 and 14 days (mean 8.3 days). E was given 30.50 mg/kg b.w. 3 times per day; duration 4 to 14 days (mean 8.6 days). Overall results were: in group B:12 cures, 5 improvements, 3 failures; 1 not assessable. In group E: 20 cures, 8 improvements, 1 failure. Side effects: in group B: vomiting (1), skin reaction (2), discontinuation (2); in group E: skin reaction (1), diarrhea (5), diarrhea+vomiting (1); discontinuation (2). The differences in efficacy and tolerability in the two groups are not statistically significant. The improved compliance with a single versus t.i.d. dosages has to be taken into account.     

Temporal lobe epilepsy caused by intrahippocampal calcified cysticercus: a case report

Lipoblastomatous lesions are mesenchymal tumors of embryonal white fat and are classified into two forms: a superficial, well-defined mass (lipoblastoma) or a deep, infiltrative lesion (lipoblastomatosis). We report an unique case of mediastinal lipoblastoma in a 17-month-old boy which harbored a dual nature and exhibited the characteristics of both forms, a large well-encapsulated intrathoracic main tumor with focal infiltrative features at the thoracic inlet and transforaminal intraspinal extension forming a long-segment extradural mass. In addition to specific signal characterization of a fatty mediastinal mass with intratumoral streaks and whorls corresponding to the fibrovascular network, magnetic resonance (MR) imaging offered clear demonstration of the chest wall, lower neck and intraspinal extension, which was important for preoperative planning.     

Mesenteric panniculitis: case report and literature review

Mesenteric panniculitis is an extremely rare inflammatory condition of the adipose tissue of unknown etiology in which the mesentery is replaced with fibrosis. Knowledge of this rare syndrome should prevent any unwarranted aggressive therapy and help to use the clinical, radiological, and surgical sources to obtain the diagnosis. This paper is a review of symptomatology, pathology, treatment, and outcome of this disorder. A case report is described that presented with obstruction of the sigmoid colon.     

Chorea gravidarum: a case report and review

A 23-year-old pregnant Pakistani female presented with hemichorea and hemiballismus at six weeks gestational age. Similar symptoms had occurred during a previous pregnancy resulting in a spontaneous abortion. Chorea gravidarum, a disorder characterized by choreiform and athetoid movement presenting during pregnancy, is rare. In the past, rheumatic disease was generally the etiology, but today, collagen vascular disease should also be considered. Treatments include neuroleptics for symptomatic relief and therapies targeted toward the underlying pathology.