Calcification at the posterior pole in scleritis. A case report

To explore the expression of proliferating cellnuclear antigen (PCNA) and tumor suppressor gene P53 product in mucoepidermoid carcinoma of the salivary glands, we studied 41 cases by immunohistochemical method. All of the cases were PCNA positive. The positive index, distribution pattern and cellular staining intensity for PCNA expression were correlated with carcinoma grade. P53 protein expression was found in 17 (41.5%) of the 41 cases; among them the expressions were weak in 9 cases. These results indicate that positive index, distribution pattern and cellular staining intensity of PCNA expression may be served as an indicator for evaluating the differentiating degree of the tumor.     

Nodular cutaneous lupus mucinosis: report of a case and review of previously reported cases

OBJECTIVE: The study was designed for the analysis on data of 51 patients with macular branch retinal vein occlusion (McBRVO) and the comparison between them and 210 patients (214 eyes) with major branch retinal vein occlusion (MjBRVO). METHODS: Fluorescein angiography, ophthalmoscope and slit-lamp were used for the examination of the venous obstructive site and the locations of artery and vein. RESULTS: (1) The incidence of McBRVO was 19.5% (51/261) in branch retinal vein occlusion. (2) The site of occlusion: the incidence of McBRVO at supero-temporal branches was 72.5% (37/51) and the incidence of MjBRVO was 73.4% (157/214). (3) The involved branch at the first macular branch accounted for 39.6%, the second branch 58.3%, and the third branch 2.1%. The artery anterior to the vein at arteriovenous crossing at the obstructive site accounted for 93.0% in the McBRVO group and 95.0% in the MjBRVO group. (4) The complications and visual prognosis: The incidence of cystoid macular edema was 20.0% in McBRVO group and that was 28.5% in the MjBRVO group. No neovascularization was found in the McBRVO group, while 37.9% neovascular formation was found in the MjBRVO group. The visual acuity recovered to 0.5 or better was in 88.2% in the McBRVO group, while 57.0% in the MjBRVO group (P < 0.005). CONCLUSION: There are no significant differences in sex, age, laterality, pathogenesis as well as occlusion site between the McBRVO and MjBRVO groups, but the visual prognosis is better in the former than that in the latter group.     

结节性硬化症一家系4例报告

结节性硬化症(TSC)是一种常染色体显性遗传病,发病率为1/600-1/15400,以皮脂腺瘤,癫痫,智力低下为主要临床表现.癫痫发作为儿童最常见的主诉症状,发生率可达80% ～90%,开始常为痉挛样发作或失张性发作,随年龄增长,渐变为局限性发作或强直阵挛性发作,多数在2岁内发病,用抗癫药物可以控制.     

Idiopathic granulomatous vasculitis: response to immunosuppressive therapy

A case of idiopathic granulomatous vasculitis (disseminated visceral giant cell arteritis) is described in an old woman, the seventh case of this rare disorder reported to date. The main organ affected was the liver and, to our knowledge, this is the first patient to be diagnosed while still alive and the only case to have received medical treatment. It is also the first time that muscular involvement has been documented in this condition. Cyclophosphamide treatment resulted in disappearance of symptoms and increase in weight. The patient died of an unrelated condition.     

Heat stroke and fluphenazine therapy: report of a case

A fatal case of heat stroke in a 21-year-old man with chronic schizophrenia is reported. Phenothiazine therapy is thought to have been a factor of major importance in the induction of this syndrome. These cases may become the responsibility of the medical examiner, and the importance of obtaining a complete drug history is stressed.     

Intravenous immunoglobulin therapy in POEMS syndrome: a case report

One course of intravenous immunoglobulin was tried on a patient with the syndrome of polyneuropathy, organomegaly, endocrinopathy, M-protein and skin lesions and Castleman's disease. No effect was noted.     

Electroconvulsive therapy in a twin pregnancy: a case report

We present a case of twin gestation complicated by severe depression and psychotic behavior; the mother was treated with electroconvulsive therapy (ECT). She had received multiple medications for treatment of her depression earlier during the first part of the pregnancy. However, frequent use of ECT later in the course of pregnancy did not result in adverse fetal outcome as is evident from normal fetal surveillance tests. We conclude that, when indicated, ECT during pregnancy improves maternal condition and does not adversely affect fetal well-being.     

Cognitive therapy of psychotic depression: A case report.

Treatment with cognitive therapy (milieu therapy and 12 individual sessions) was associated with significant clinical improvement and reduction of symptoms on measures of mood and cognition in a 21-yr-old female psychotic depressive. Cognitive restructuring as proposed by A. T. Beck et al (1979) was emphasized. Improvements were noted through the use of the Beck Depression Inventory and the Hamilton Rating Scale for Depression. Results were achieved without the use of medication. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Wegener's granulomatosis, immunosuppressive therapy

We present a study of 11 patients with Wegener's granulomatosis. Seven of these were treated with Azathioprine (Imurel) combined with prednisone. Of these, 4 patients rapidly improved after the treatment was started. Atelectatic changes in the lungs disappeared. A rapidly progressive renal failure was reversed, and renal function returned to normal. Large lesions of the skin also improved. The treatment has now lasted 2 1/2-4 1/2 years without interruption. We have not had any serious side effects due to Imurel. We believe that the good effect of the treatment is due to immunosuppression by the drugs.     

Electroconvulsive therapy decreased bispectral index--a case report

A 28-year old female schizophrenic patient underwent electroconvulsive therapy (ECT) under propofol anesthesia. She received ECT five times, and Bispectral Index (BIS) was recorded four times out of the five ECT. BIS values (mean +/- SD) were 95.3 +/- 1.3 before anesthesia, 38.0 +/- 13.1 after loss of consciousness, 45.3 +/- 12.7 immediately after ECT and 27.3 +/- 11.6 about two minutes after ECT. In conclusion, ECT may decrease BIS during continuous propofol infusion.     

Successful surgical treatment for fungal endocarditis involving the aortic valve: report of a case

A 50-year-old man who had undergone successful aortic valve replacement for fungal endocarditis was presented. He had been doing well until October 1993, when he suddenly developed shock with high fever. In two weeks he recovered from septic shock with vigorous medical treatment including intravenous administration of antibiotics. The infecting organism was not detected on repeated blood cultures. Four months later he was admitted to our hospital because of left heart failure. Although he was afebrile on admission, a two dimensional echocardiogram revealed vegetation on the aortic valve and massive aortic regurgitation. Inflammatory signs persisted and the vegetation increased in size, and therefore an aortic valve replacement was performed. A surgical specimen of the aortic valve revealed perforation in each of three cusps and vegetation on the non-coronary cusp. Pathological exploration revealed typical colonies of fungi. Following the diagnosis of fungal endocarditis, administration of an anti-fungal drug was started. His post-operative course was uneventful, and there was no evidence of recurrence with the anti-fungal medication for one year postoperatively.     

Nodular mucinosis of the breast: report of three cases

Three cases of nodular mucinosis of the breast are presented. They occurred in one male and two female patients. The patients had no signs of Carney's syndrome. All lesions were located under the nipple. They were poorly circumscribed and unencapsulated. They were soft and had a gelatinous consistency and white color. No patient had any evidence of recurrence or metastasis 6 months, 3 years and 6 years, respectively, after the surgical excision. The mucinous tissue consisted of acid mucopolysaccharides, which stained Alcian blue, Hale's colloidal iron positively, and they were periodic acid-Schiff (PAS) negative. Mucicarmine reaction was only faintly positive. The lesion should be distinguished particularly from mucocele-like lesions of the breast by the location, nodular arrangement, absence of accompanying ductal hyperplasia and staining properties of the mucous substances.     

Elbow dislocation during overhead skeletal traction therapy: a case report

A dislocation of the elbow occurred in a 7-year-old boy during overhead skeletal traction treatment for a supracondylar fracture of the humerus. Closed reduction of the dislocation was successful. A review of the literature failed to reveal a report of a similar incident.     

Coping with dietary therapy in phenylketonuria: A case report.

Describes the long-term effects of maintaining the diet required for treatment of phenylketonuria in a 7-yr-old girl on 1 family's eating and mealtime events. A behavioral/family systems oriented assessment was taken using a battery of tests including the McCarthy Scales of Children's Abilities, Wide Range Achievement Test, the Child Behavior Checklist, and an eating behavior inventory. An intervention program is described, utilizing family systems oriented/parent training and individual child sessions. Implications for enhancing dietary adherence and long-term management of dietary therapy are discussed. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A case of necrotizing scleritis associated with Epstein-Barr virus infection

Recently Epstein-Barr virus (EBV) is often reported in association with ocular disease. But EBV has not been reported to cause necrotizing scleritis. A 71-year-old woman developed ciliary injection and peripheral corneal ulcer in both eyes. The lesions did not respond to topical steroid and systemic indomethacin. The sclera became transparent and perforated. EBV serologic antibody titers were strongly positive. Anti-viral capsid antigen (VCA)-IgG was 1: 1,280 and anti-early antigen (EA)-IgG was 1: 640. These serologic results suggested active EBV infection. Using immunofluorescence techniques, the squamous epithelial cells of the conjunctiva were stained with monoclonal antibody against EBV-VCA and strongly stained with antibody against IgG. The results of serologic test and the immunofluorescence techniques appeared to suggest that the necrotizing scleritis was caused by EBV.     

Rapid growth of glioblastoma during therapy for multiple myeloma: case report

Rapid growth of a glioblastoma during therapy for multiple myeloma is reported. A 53-year-old man was admitted to our hospital with a right costal tumor, which was resected. The diagnosis was plasmocytoma. Urine protein electrophoresis showed a monoclonal peak in the region of gamma-globulin, and examination of the bone marrow revealed 17.8% of atypical plasma cells. Brain magnetic resonance (MR) imaging detected two small lesions, but these could not be identified as brain tumor. He received chemotherapy (melphalan 10 mg/day and predonin 30 mg/day for 4 days) and was discharged. Two weeks after discharge, he was readmitted because of left hemiparesis. T1-weighted MR imaging showed two large hypointense lesions in the right frontal lobe, with ring-like enhancement following Gd-DTPA infusion. 1H-MR spectroscopy showed typical findings of tumor with increased choline and lactic acid peaks. 201Tl SPECT revealed high accumulation in both early and delayed images. Right carotid angiography showed a hypervascular tumor with venous filling and mass effect. The lesions were resected via right frontal craniotomy, followed by intraoperative radiation and placement of an Ommaya reservoir. Histological examination showed the tumors were glioblastoma. The brain between the tumors also showed the typical appearance of glioblastoma, suggesting that the lesions were continuous. Postoperatively, the patient's left hemiparesis disappeared. He received local irradiation and chemotherapy and was then discharged. Coexistence of glioblastoma and multiple myeloma is rare. The cause may be genetic abnormality, but immunodeficiency due to multiple myeloma, surgical damage, or chemotherapy may have contributed to the rapid growth of the glioblastoma.     

Resolution of hyperparathyroidism associated with immunosuppressive therapy

The documentation of patient care is a critical nursing function. In addition to confirming that the nurse has practiced within the standards of care, the documentation is intensely scrutinized by those making payment and legal decisions. With the stroke of a pen or the tap of a keyboard the nurse records a fact or observation that will forever be a part of the data base. That data base may be used to determine benefits, allocate resources, settle legal arguments and even weigh criminal justice. Charting on the patient's record is both a privilege and a responsibility. It is not to be taken lightly. Every effort should be made to write from the perspective of a neutral reporter. The scope of documentation should be comprehensive and relevant. Observations should include the realms of psychosocial and emotional concerns as well as the physical. It is not necessary to make judgements or draw conclusions about the observations charted. It is enough to record pertinent assessments, actions and outcomes. It is from a database with these characteristics that we may be assured we are practicing in an ethical and responsible manner.     

Placenta previa percreta involving the left broad ligament and cervix. A case report

BACKGROUND: Placenta previa percreta with invasion of the broad ligament and uterine cervix is an extremely rare condition and carries high maternal and fetal morbidity and mortality. CASE: A 39-year-old, multiparous woman with two previous cesarean sections presented in active labor at term with placenta previa percreta involving the left broad ligament and cervix. The patient was managed by antepartum diagnosis of placenta previa accreta, supracervical hysterectomy, and blood transfusion. CONCLUSION: This case was managed consistent with the literature, and favorable maternal and fetal outcomes were achieved.