The diagnosis of pericardial effusion and cardiac tamponade by 12-lead ECG. A technology assessment

Two types of receptor for tumour necrosis factor-alpha (TNF-R), the 55-kD receptor (TNF-RI) and the 75-kD receptor (TNF-RII), have been identified. Soluble TNF-RI (sTNF-RI) and soluble TNF-RII (sTNF-RII) can be measured in culture supernatants and biological fluids, and the role of sTNF-R has been suggested. In the present study, we measured plasma sTNF-RI and sTNF-RII levels in 19 patients with active sarcoidosis by ELISA in order to assess the state of both types of receptors in this disease. Both plasma sTNF-RI and sTNF-RII levels in patients with active sarcoidosis were significantly higher than those in normal control subjects. A longitudinal evaluation of plasma sTNF-RI and sTNF-RII levels showed that the magnitude of changes in sTNF-RII was closely related with the clinical course of sarcoidosis. These results suggest that plasma sTNF-RII levels may be useful parameters for monitoring the clinical course of sarcoidosis as well as markers for identifying disease activity.     

A transitional variant of Castleman's disease presenting as a chylous pleural effusion

Castleman's disease is an uncommon clinicopathologic entity that results in unregulated growth of lymphoid tissue. It may present as benign involvement of one lymph node group or as multicentric disease with serious systemic symptoms. Pleural effusions are an uncommon manifestation of Castleman's disease. We present a patient with Castleman's disease who initially presented with a chylous pleural effusion.     

Manson's schistosomiasis presenting as a brain tumor. Case report

Neurological complications arising from schistosomiasis are uncommon, and reports of Manson's schistosomiasis presenting as an intracerebral mass lesion are particularly rare. The authors describe the case of a 26-year-old man with a 3-month history of headaches and visual abnormalities. He had immigrated to Canada from Brazil 4 years previously. The patient's general physical and neurological examinations were unremarkable. Magnetic resonance (MR) imaging revealed an enhancing lesion with surrounding edema and mild mass effect in the right occipital lobe. A stereotactic brain biopsy demonstrated intraparenchymal granulomas surrounding Schistosoma masoni eggs. The patient's symptoms resolved following treatment with praziquantel and steroid medications; follow-up MR imaging yielded normal findings. This case demonstrates that neuroschistosomiasis should be considered when an individual presenting with an intracerebral mass has lived in a region in which this disease is endemic.     

Chondroma of the petrous bone. A contribution to differential skull base tumor diagnosis

INTRODUCTION: Cartilaginous tumors of the mid-face and the skull base are rare. CASE REPORT: For the first time, a case report of a chondroma of the base of the ear in a 56-year-old woman is presented. In 1974 the patient developed a facial nerve paralysis while she was pregnant. Twenty-two years later the patient developed persistent headache and CT studies of the head were obtained, which showed an extensive tumorous lesion located at the base of the ear. A tumor was resected through an otoneurosurgical approach. The histological examination showed a chondroma. CONCLUSIONS: Even the rare diagnosis of a chondroma should be considered for a differential diagnosis of skull base tumors.     

Cervical actinomycosis. A rare differential diagnosis of parotid tumor]

BACKGROUND: Allergic rhinitis is usually treated with oral antihistamines or nasal steroids. Topically active nasal antihistamine is a new treatment modality for allergic rhinitis. The efficacy in comparison to well established topical treatment alternatives is not fully known. OBJECTIVE: To compare the efficacy of intranasally administered azelastine to budesonide, at their respectively recommended dosage, on the symptoms of perennial rhinitis patients. METHODS: A placebo-controlled, randomized, parallel group study was conducted to compare the efficacy and tolerability of intranasal budesonide aqueous suspension (256 microg once daily) with azelastine hydrochloride nasal spray (280 microg twice daily (560 microg/day)) and with placebo in the treatment of perennial allergic rhinitis. The 195 patients (with at least a 2-year history of perennial allergic rhinitis) recorded individual nasal symptom scores, the degree of symptom control achieved and any adverse events experienced over a 2-week baseline period and a 6-week treatment period. RESULTS: Following treatment, the reductions in mean combined and individual nasal symptom scores from baseline values were significantly greater in the budesonide group compared with the placebo group (P < .0001 for all variables except runny nose P = .01). In patients treated with budesonide, there were also significantly larger reductions from baseline values in combined nasal symptom scores (P < .01) and in scores for all individual nasal symptoms (P < or = .05) compared with those treated with azelastine. The reductions from baseline in both combined and individual nasal symptom scores did not differ between azelastine and placebo. The study medications were well tolerated, producing no unexpected or serious treatment-related adverse events. CONCLUSION: A once-daily dose of 256 microg of intranasal budesonide aqueous suspension is significantly more effective at relieving the symptoms of perennial allergic rhinitis compared with a twice daily dose of 280 microg of azelastine nasal spray.     

Mediastinal angiography. A helpful method to evaluate to operability of mediastinal and lung tumors (author's transl)

Preoperative mediastinal angiography, as a simple method, shows alterations of pulmonary and venous mediastinal circulation. It enables the surgeon to evaluate the operability of malignant thoracic neoplasms without performance of other diagnostic procedure with a higher rate of complications, e.g. mediastinoscopy or explorative thoractomy.     

Depressive stupor--malignant neuroleptic syndrome--serotonin syndrome. A case contribution to a difficult differential diagnosis]

PURPOSE: Our goal was to assess, with a prospective study, the role of hysterosalpingo-contrast sonography (HyCoSy) with an echocontrast agent and transvaginal ultrasonography alone in the evaluation of tubal status. METHODS: Thirty patients were included in the study. These patients underwent an initial plain transvaginal ultrasound examination the day before the HyCoSy. The findings obtained from both examinations were compared with laparoscopic diagnosis, performed in the same menstrual cycle. RESULTS: The kappa values were 0.48 for patency evaluation and 0.67 for the diagnosis of the presence of at least one patent tube, suggesting a good agreement in both cases between HyCoSy and surgery. HyCoSy had a significantly lower sensitivity (50%), but not a significantly higher specificity (75%), than transvaginal ultrasonography alone in the diagnosis of tubal infertility-related abnormalities such as peritubal adhesions. CONCLUSIONS: The study demonstrates that the HyCoSy is a useful test when scheduling the most suitable treatment for infertile couples.     

Pain due to epidural tumor in cancer patients. Report of two cases and differential diagnosis

INTRODUCTION: Blood is generally used for detection of antibodies associated with infections. However, removal of blood samples can be problematic and is painful for the patient. It requires suitable equipment and skilled staff, both of which may be expensive. Some patients refuse to allow removal of blood samples because they find it painful and traumatic. Removal of blood samples from children, newborns, immunocompromised or overweight subjects is often particularly difficult. In addition, some religions forbid the taking of blood samples. Thus, it is necessary to develop alternative, simple, painless methods of sampling body fluids that give results as accurate as those obtained with blood samples. Saliva has been suggested as a possible alternative. Epidemiological studies and other reports have shown that saliva may be of value for the detection of HIV antibodies. AIM: To evaluate the potential of saliva for detection of antibodies and seroconversion. MATERIALS AND METHODS: Section I: Saliva and serum from 1,023 subjects, including 150 AIDS patients, 251 TB patients of known HIV status and 622 subjects from at-risk groups were tested. Sera from subjects with unknown HIV status were systematically tested by Abbott recombinant HIV1/HIV2 EIA. Section II: Saliva and sera were obtained from a population at risk of HIV infection. Two hundred and fifty consenting adults were found to be HIV-negative. Saliva was collected from each subject once per week and tested the same day with the Abbott test pack and Wellcozyme GACELISA. A spot of blood was also collected, dried and tested using the Wellcozyme GACELISA protocol. Whenever a positive result was obtained for any test, a blood sample was taken the same day or as soon as possible, for Western, blot analysis. Saliva was collected with an OMNISAL device (SDS, Vancouver, USA) placed under the tongue. The indicator turned blue when enough fluid had been collected. The device was then removed and the saliva placed in a tube with stabilized product. It was then transferred to a casting tube with a filter. RESULTS: Section I: Saliva from 96 of 150 AIDS patients (64%) tested positive. Serum from these patients also tested positive for HIV. Thirty-two subjects of the 622 from at-risk groups tested positive for HIV in the Abbott recombinant HIV1/HIV2 EIA with saliva (5.14%). Serum from these subjects also tested positive for HIV in Western blot. However, saliva EIA gave 5 false negative results for patients who tested positive in rapid tests and Western blot. We optimized the procedure and obtained 98.69% sensitivity and 100% specificity. Section II: One individual tested positive in saliva and dried blood spot tests in the fourth week of the study. Western blot using serum samples obtained on the next and following days showed a progressive increase in the intensity of the bands, beginning with P24 and GP160 (Fig. 2). CONCLUSION: This study shows that testing saliva is effective for determining HIV status early in seroconversion.     

The future of partial correlation as a means to reduce halo in performance ratings.

Examines the practice of statistically controlling for halo effects in performance ratings. It is argued that there are 2 major problems with the partial correlation approach to removing halo from ratings data. First, the correct use of the technique depends on the validity of specific causal assumptions regarding the rating process that have not received empirical evaluation to date. The 2nd problem concerns analytic procedures employed in previous tests of the partialing approach. Reanalysis of data reported by F. Landy et al (see record 1981-00274-001) indicates that previous conclusions regarding the effectiveness of partialing may have been artifacts of the way the data were analyzed. It is felt that criticisms of the partial correlation approach to halo reduction are sufficient to suggest suspension of its use in any nonresearch context until necessary additional research is performed. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Amyloid angiopathy as a clinico-pathological entity to consider in the differential diagnosis of any hemorrhagic cerebrovascular accident

Intracerebral hemorrhages represent about 10% of the whole of vascular cerebral accidents. According to different authors, the incidence of cerebral amyloid angiopathy varies between 5-10% and up to 20-30% of all primary non-traumatic intracerebral hemorrhages. This incidence was analyzed in our environment. A retrospective study was carried out on 403 patients, 203 of them were analyzed between 1990-91 and the other 200 between 1992-3. Age, arterial tension, relapses and localization were taken as criteria for a diagnosis. For the statistical analysis, Student's T-test was used for quantitative variables, while square Chi with Yates' correction was used for qualitative variables. Ischemic cerebral accidents (90.5% of the total) are more frequent than hemorrhagic cerebral accidents, which represent 5.7%. 3.7% were not registered. Therefore, it was suspected cerebral amyloid angiopathy in 1.4% of all vascular cerebral accidents. This represents 26.1% of the total of hemorrhagic patients. Different variables from groups of hemorrhagic vascular cerebral accidents were compared to those caused by amyloid cerebral angiopathy and significant statistics were found with respect to localization in the cerebral hemispheres (p < 0.01). Neither age, nor arterial tension or relapses were significant. Amyloid cerebral angiopathy as a cause of hemorrhagic cerebrovascular accident is and entity to be considered in the diagnosis of these patients. By using clinical criteria and others of localization through complementary explorations, a diagnosis for guessing such a process can be determined.     

A warning about the use of a standard deviation across dimensions within ratees to measure halo.

Monte Carlo data show that the unstandardized standard deviation measure of the halo effect is affected by both the intercorrelation among rating dimensions and differences among the means of the rating dimensions as used by individual raters. The relationships between 4 different halo measures are analyzed, and the results of 2 studies using the unstandardized measure are examined to determine the degree to which the problem seems to have affected published data on the halo effect. It is recommended that each rater's average observed intercorrelation among the dimensions be used as a halo measure. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Demyelinating disease versus tumor in surgical neuropathology. Clues to a correct pathological diagnosis

Clinical presentations as well as radiological and histopathological findings in biopsies from patients with multiple sclerosis (MS) or other demyelinating disorders of the central nervous system are sometimes misleading, resulting in an erroneous diagnosis of brain or spinal cord tumor. We report 17 patients who presented with symptoms mimicking those of brain (14 cases) or spinal cord (three cases) tumors. Computerized tomography or magnetic resonance imaging studies or both were interpreted as consistent with a tumor in each case. All patients underwent surgery, and all 17 pathological specimens were eventually diagnosed as showing demyelinating disease, usually consistent with MS. In each case we examined a variety of histological features and immunohistochemical studies and addressed their relative importance in considering the diagnosis of MS. All cases showed perivascular lymphocytic inflammation with variable amounts of macrophage infiltration, necrosis, and edema. The hypercellularity of the lesions and the presence of atypical reactive astrocytes with mitotic figures were the disturbing features that might have led to the erroneous diagnosis of an astrocytic neoplasm. Immunohistochemistry for astrocytic (glial fibrillary acidic protein) and macrophage (HAM-56) markers are helpful in evaluating biopsies. Our results emphasize the need to perform special stains (i.e., for myelin and axons) that demonstrate myelin loss and relative preservation of axons and allow a correct diagnosis.     

Arteriovenous malformation presenting as a complex pelvic mass with ureteral obstruction. A case report

BACKGROUND: Arteriovenous malformations (AVMs) are an abnormal communication between arterial and venous structures. Pelvic AVMs have been infrequently described in the literature and represent an uncommon cause of a palpable pelvic mass. CASE: A case of pelvic AVM with ureteral obstruction occurred. The location and radiologic appearance of the AVM suggested a complex adnexal mass. During exploration and resection of the mass, significant bleeding was encountered. The diagnosis of AVM was made only retrospectively, with histologic examination of the specimen. CONCLUSION: AVMs are an uncommon and unique cause of pelvic pathology. Preoperative diagnosis will alert the surgeon as to the technically difficult resection that may be encountered and to the massive bleeding that can be associated with their removal.     

A case of neuro-Beh?et's encephalitis with pleds as distinct from herpes simplex encephalitis: a differential diagnosis

We report a male patient with neuro-Beh?et's disease who had somnolence, mild motor aphasia and periodic lateralized epileptiform discharge. SPECT study showed decreased cerebral blood flow in the left frontal and temporal lobes. An MRI scan of the head showed only mild brain stem atrophy. His clinical signs were markedly improved after administration of prednisolone. We propose that some cases of neuro-Beh,cet's disease may have very similar clinical features to herpes simplex encephalitis and that SPECT and MRI examinations can be very useful in distinguishing the ischemic lesion of neuro-Beh?et's from the inflammatory lesion of herpes simplex encephalitis.     

Giant fibroadenoma of the breast. Its clinical picture and differential diagnosis. A report of a clinical case

The Schizosaccharomyces pombe genes, nda1 and nda4, are essential for the normal regulation of DNA replication and belong to the MCM gene family. This gene family includes Saccharomyces cerevisiae MCM2, MCM3, MCM5/CDC46 and CDC47, S. pombe nda1, nda4, cdc21 and mis5, and genes encoding human BM28, P1MCM3 and P1.1MCM3 and mouse P1MCM3, most of which are considered to be required for the initiation of DNA replication. We isolated two homologues of the MCM genes, xMCM2 and xCDC46, from a Xenopus laevis cDNA library using the polymerase chain reaction (PCR) method. The predicted amino acid (aa) sequences of xMCM2 and xCDC46 are most similar to those of human BM28 (78% identity) and S. pombe Nda4 (48% identity), respectively. By Western blot analysis using anti-xMCM2 and anti-xCDC46 polyclonal antibodies (Ab) raised against glutathione S-transferase (GST)::xMCM2 or GST::xCDC46 fusion proteins, xMCM2 and xCDC46 were identified as 120- and 95-kDa proteins, respectively. When either xMCM2 or xCDC46 was immunoprecipitated with the specific Ab, the other was also co-precipitated. These results suggest that xMCM2 and xCDC46 physically interact with each other.