Computed tomography-guided biopsy of the spine. A review of 103 patients

PURPOSE: This study was performed to evaluate relations among neutrophil count (including its course), type of lesion, treatment, and prognosis in patients with leukemia and perianal infection. METHODS: Medical records of patients with acute and chronic leukemia who were followed during the last five years were reviewed retrospectively. RESULTS: The incidence of perianal infections was found to be 7.3 percent in 259 patients with acute leukemia. Only 1 of 108 patients with chronic leukemia suffered from this problem. Twenty percent of all patients with this complication died as a result of sepsis. Perianal abscess was the sole and obligatory indication for surgical treatment in our patients. There were ten patients in each treatment group. The operative group had better results (9 cures, 1 complication vs. 3 cures, 7 complications). However, median neutrophil count at diagnosis was notably higher in the operative group 1,280/mm3 vs. 96/mm3; P = 0.075). Also, significantly more frequent abscess formations and, consequently, operative treatments were performed in patients with a period of normal neutrophil counts during the infection compared with continuously neutropenic patients (9 operative, 4 nonoperative vs. 1 operative, 6 nonoperative; P = 0.057). Ten cures, three complications vs. two cures, five complications (3 mortalities) were present in patients with and without normal neutrophil counts, respectively (P = 0.062). When only severely neutropenic patients were considered, four patients in the surgery group had normal neutrophil counts before or shortly after surgery. However, only two of eight patients with perianal cellulitis had normal counts during full-course infection (P = 0.06). CONCLUSIONS: The course of the neutrophil count during infection was an important factor affecting the perianal lesion, and indirectly, choice of treatment and prognosis. A period of normal counts during infection usually led to well bordered and fluctuant lesions, and the prognosis was acceptable with operative treatment. However, continuously neutropenic patients developed nonfluctuating indurations. We found disappointing results with nonoperative treatment of such patients. In all studies, regarding treatment of perianal infections in neutropenic patients, the course of the neutrophil count and indications for surgery should be clarified to get reliable results.     

Voluntary muscle involvement in hypertrophic cardiomyopathy. A study of eleven patients

Hypertrophic cardiomyopathy is generally considered to be a primary disease of cardiac muscle, although several clinical observations suggest that the pathologic process might be more diffuse. To further examine this possibility, electromyography and voluntary muscle biopsies were done on 11 patients with hypertrophic cardiomyopathy. In 10 of 10 patients electromyography showed reductions in mean potential amplitude and duration, with an increased incidence of short-duration polyphasic deflections (findings traditionally accepted as indicative of a myopathic process). Light and electron microscopic studies of the biopsy material showed abnormalities in eight of 11 patients: four had central core or target fibers, or both, and two of these, plus four others, had subsarcolemmal mitochondrial proliferation with or without abnormal ultrastructure. These findings indicate that hypertrophic cardiomyopathy is only one aspect of a larger disease spectrum, with abnormalities in both voluntary and cardiac muscle.     

Disseminated histoplasmosis in AIDS patients. A study of 2 cases and review of the Spanish literature

The characteristics of two cases of histoplasmosis in AIDS patients in our institution are presented together with a review of the 11 cases published in Spain since 1988 in addition to the current knowledge on histoplasmosis in patients with human immunodeficiency virus infection (HIV). In all except 2 of the 13 patients there was epidemiologic history of a stay in a country in which histoplasmosis is endemic. The 12 cases described in which this information is available had CD4 counts under 100/microL. The clinical manifestations of presentation were fever (92.3%) associated or not with other unspecific symptoms (asthenia, anorexia, cough, diarrhea) with a subacute course of two or three months. Physical examination demonstrated hepatosplenomegaly in 76.9% of the cases and 61.5% of the patients presented cutaneous lesions. Thoracic radiography was abnormal in 55% (61.5% had respiratory symptoms). Diagnosis was achieved by isolation of the fungus in the cutaneous biopsies in all the patients with dermatologic involvement and in 7 cases identification was performed in the bone marrow. In all the cases induction treatment was with anphotericin B and in those who reached the maintenance phase itraconazol was used in 7 cases and ketoconazol in one case. None of the patients treated with itraconazol, including the two in our center, presented recurrence at the time of completion of follow up. In conclusion, histoplasmosis is frequently presented as a prolonged febrile syndrome with unspecific characteristics, thus emphasizing the importance of including travel history to other countries in the anamnesis. The increase in journeys to endemic countries and immigration from these areas had led to an increase in the number of cases of histoplasmosis in patients with HIV infection in Spain.     

Histometric study of meat products. A literature review

In the present paper, the literature on the development of methods for histometric monitoring the quality of meats is reviewed. The value of specific techniques, statistical interpretation of results and the practicability of automation of histometric analysis are examined more closely. It is concluded from the study of the literature that histometric examination of meats allows an objective assessment of volume percentages of tissue components. When a distinct difference in contrast between various tissues is achieved by specific staining methods, developments in the field of image analysis systems will allow automation of the quantitative histological examination of meats.     

Testicular lymphomas. A clinico-pathological study of 5 cases and a review of the literature]

The authors describe five consecutive patients with testicular non Hodgkin lymphoma, evaluate the clinical and histological characteristics and underline the importance of a chemotherapy approach both at diagnosis and at relapse. A review of the literature is carried on and particularly about the prognostic factors, the correlation with Ebstein Barr virus and the more recent integrated therapeutical approaches.     

Gouty arthropathy of the lumbar spine: a case report and review of the literature

STUDY DESIGN: A patient with hyperuricemia developed symptoms from lateral recess stenosis attributed to gouty arthropathy of a lumbar facet joint. OBJECTIVE: To present the diagnosis and management of gouty arthropathy of the lumbar spine in one individual. SUMMARY OF BACKGROUND DATA: The symptoms and treatment of a patient with intra-articular gout of a lumbar facet are presented and contrasted with other cases of spinal extra-articular gout found in the literature. METHODS: A patient with hyperuricemia reported back pain and symptoms consistent with lateral recess stenosis. Conservative treatment failed, and, after further evaluation, a successful decompressive laminectomy was performed. Pathology revealed intra-articular urate crystal deposition. RESULTS: This patient's unilateral S1 radiculopathy corresponded with magnetic resonance and computed tomography studies documenting unilateral lateral L5-S1 lateral recess stenosis secondary to intra-articular gouty arthropathy. As anticipated, the serum uric acid also was elevated. Since surgical decompression with unilateral laminotomy was performed, the patient has been symptom-free for 2 years. CONCLUSION: Although rare, gouty arthropathy of the lumbar facet joint should be considered in all patients with neurologic symptoms and known or suspected gout. Optimization of pharmacologic treatment is indicated for patients suspected of having gouty neuropathy. Surgical decompression is indicated if conservative management with Indocin, nonsteroidal anti-inflammatory agents, and allopurinol fails to reverse neurologic dysfunction.     

Laparoscopic treatment of a diaphragmatic hernia through the foramen of Morgagni in children. A case report and review of eleven cases reported in the adult literature

A new case report of laparoscopic repair of a diaphragmatic hernia through the foramen of Morgagni in a 11-year-old boy with Down's syndrome is described. The review of 11 other cases in the adult literature illustrated the various aspects of this laparoscopic approach.     

Orofacial manifestations of Melkersson-Rosenthal syndrome. A study of 42 patients and review of 220 cases from the literature

We investigated orofacial manifestations in 42 patients with Melkersson-Rosenthal syndrome who were examined at our institution between 1965 and 1990. Patient histories and histologic and clinical findings were reviewed in detail. These data were compared with the oral findings in 220 cases that were reported in the literature between 1965 and 1990. There were 28 females in our study. The age at onset of signs and symptoms varied widely with a mean of 33.8 years. Most frequent initial signs were labial edema, facial swelling, and Bell's palsy. During the course of the disease, 75% of all patients had labial swelling, 50% had facial edema, and 33% had Bell's palsy. Swelling, erythema, or painful erosions that affected the gingiva, buccal mucosa, palate, or tongue were common intraoral symptoms. A comparison with patients reported in the literature revealed a similar frequency of extraoral symptoms but more prevalent intraoral symptoms in our patients.     

Biliary dyskinesia: a study of more than 200 patients and review of the literature

The aim of this study was to establish, by means of peripheral quantitative computed tomography (pQCT) at the distal radius, the existence of cortical and/or trabecular osteopenia, and to assess the integrity of bone geometry in uremic patients undergoing maintenance hemodialysis. Our results show a clearcut selective reduction in volumetric cortical density, more evident in women (p = -0.0001) than men (p = 0.030), which appears to be independent of age and menopausal status. Trabecular density was not significantly changed in either sex. Cortical density of the patients correlated inversely with age (p = 0.003), duration of dialysis (p = 0.002) and parathyroid hormone (PTH) levels (p = 0.03). Trabecular density correlated only with age. Normally, cortical density is age-dependent and its reduction is accompanied by compensatory geometry changes. Compared with control subjects, in our female patients both cortical area and cortical thickness were reduced (p = 0.02 and 0.008), while cross-sectional area did not change (p = 0.67). Conversely, in the males only cross-sectional area was reduced (p = 0.02). In conclusion, in uremic patients we observed a selective cortical osteopenia, more evident in the female sex, and a sex-specific pattern of geometry impairment, with resultant apparent increased bone fragility in the uremic women. We suggest that the prolonged PTH excess could be responsible, directly and/or interacting with estrogen deficiency.     

Update on lumbar spinal stenosis. Retrospective study of 62 patients and review of the literature

Bactenecin 5 (Bac 5), a cationic antibacterial peptide, contains a repeating region of Arg-Pro-Pro-X (X = hydrophobic residue). To investigate the structure and property of a Pro/Arg-rich region, we synthesized a series of repeating peptides, Ac-(Arg-Pro-Pro-Phe)n-NHCH3 (n = 2, 4, 6, 8 and 10) (PR2, PR4, PR6, PR8 and PR10) as models. The circular dichroism (CD) study suggested that the peptides with longer repeats, PR6, PR8 and PR10, formed a conformation similar to poly(proline)-II in aqueous solution. The CD spectra did not change in the presence of dipalmitoyl-DL-alpha-phosphatidylcholine (DPPC), but they changed in the presence of DPPC/ dipalmitoyl-DL-3-phosphatidylglycerol (DPPG). The gamma-helix, which is very similar in conformation to the poly(proline)-II helix, had the lowest energy conformation for the peptides by energy calculations. Peptides PR6, PR8 and PR10 caused slight leakage of fluorescent dye entrapped in DPPC vesicles, and in the presence of DPPC/DPPG, these peptides showed a considerable level of dye-leakage activity. In contrast, the shorter peptides PR2 and PR4 showed no activity. The same tendency was found in measurements of membrane-fusion activity. Judging from these results, the repeating region of Bac 5 may make a framework to hold a conformation resembling the poly(proline)-II structure in aqueous solution. In addition, this region may interact with acidic lipids, resulting in a change in conformation of the peptide.     

Intrapericardial teratoma. A case report and a literature review

A case of newborn intrapericardial teratoma is reported. The clinical, echocardiographic, tomographic and histologic features are described, and also, the therapeutic options. The newborn was submitted to surgical excision of the intrapericardial tumor and has a clinical follow-up greater than four years.     

Bulimia: A review of the literature.

This overview of bulimia research reports findings concerning demographic variables, psychopathology, and treatment outcome effects. While both bulimics and sufferers of anorexia nervosa are abnormally concerned with body weight, the bulimics tend to fluctuate between weight loss and weight gain. The incidence of bulimia in the general population is generally unknown; however, it is more prevalent in women than men. Bulimic individuals are obsessed with thoughts of food and weight; they also experience depression and anxiety. While treatment approaches have included anticonvulsive medication and other drugs, group experiential-behavioral treatment, a cognitive behavioral approach, and behavior therapy, it appears that interventions based on behavior therapy generate the best evidence for successful outcome in treating this eating disorder. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression and immunocompetence: A review of the literature.

Recent evidence suggests that there is a relationship between depression and immunity. On the basis of these studies, it has been argued that depressed mood may increase susceptibility to disease by means of aberrations occurring within the immune system. Empirical research investigating the relationship between depression and immunity is reviewed here. Studies examining both clinical and nonclinical manifestations of depression are discussed and evaluated. This review reveals that indexes of immunocompetence are lower among people exhibiting depressive symptomology and suggests that immune alterations may be more related to dysphoric mood than to specific situations or events. Alternative hypotheses accounting for links between depressed affect and altered immune states are provided, and suggestions for future research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Management of patients with pyogenic complications of long bones open fractures

122 patients with purulent complications of open diaphyseal fractures of long bones were treated. Comparative analysis of different surgical methods for treatment of pyogenic complications has shown that the most effective method is one of active sanation of the area of inflammation with the use of combined drainage ensured successful and steady decrease of pyogenic process (follow-up up to 4 years, 89.7% of patients). The drainage provides stable fixation of bones fragments by dipped fixators until consolidation of the fracture. It also promotes repain of residual diaphyseal defects without application of complicated plastic methods.     

Self-disclosure: A literature review.

Reviews the literature concerning the role of verbal disclosure of information about oneself as a personality attribute, in interpersonal relationships and in therapist-client relationships. The relationship between self-disclosure and nonverbal communication is considered. (3 p. ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A histometrical study on the long bones of raccoon dogs, Nyctereutes procyonoides and badgers, Meles meles

In June 1994, a 39 year-old male with adult T-cell leukemia was admitted to our hospital and received combination chemotherapy including epipodophyllotoxin for approximately 1 year. The monocyte count increased gradually beginning in April 1995, accelerating to 100 x 10(9)/l in January 1996, when he was diagnosed with acute monocytic leukemia. Inv(11)(q21;q23) x 2 was recognized at that time by chromosome analysis, and rearrangement of the MLL gene was shown by Southern blot analysis. From the clinical course and subsequent examinations, the case was regarded as epipodophyllotoxin-related secondary leukemia. Recently, epipodophyllotoxin has frequently been used as a treatment agent for adult T-cell leukemia. It is valuable to note that secondary leukemia may follow even such an aggressive leukemia as adult T-cell leukemia.     

Cues and concerns by patients in medical consultations: A literature review.

The aim of the current article is to review the peer-reviewed research literature on cues and concerns published between 1975 and 2006. To be included, articles had to report observational studies based on patient-physician consultations and report findings on patient expressions of cues and/or concerns. Quantitative and qualitative studies from different medical settings were considered. Fifty-eight original articles based on the analysis of audio- or videotaped medical consultations were tracked down. Definition of cues and concerns and methodological approaches differed widely. Physicians missed most cues and concerns and adopted behaviors that discouraged disclosure. Communication training improved the detection of cues and concerns. Future research progress would require different methodological approaches more appropriate for studying verbal interactions and the complexity of the various levels that influence interactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fatigue in cancer patients: a review of the literature

This paper reviews the research literature concerning fatigue in cancer patients, evaluating the quality of the evidence, thus helping to focus the direction and methodological rigour required in future investigations. Since fatigue in this population has been attributed to several mechanisms these will be discussed. The prevalence of fatigue in cancer patients will then be documented. An overview of what is currently understood about fatigue in cancer will follow. Based on the literature, conceptual and methodological difficulties will be described. Finally, gaps in understanding will be identified. Suggestions for future research will be formulated and potential interventions to decrease feelings of fatigue explored.     

Ophthalmoplegia-ataxia-areflexia in pediatrics. Three new patients and review of the literature

OBJECTIVE: The objective of this study was to investigate if pediatric patients with benign brainstem encephalitis (Bickerstaff Syndrome) or with Miller-Fisher Syndrome are the extremes of the same nosological entity which, in adults, has been named ophalmoplegia-ataxia-areflexia syndrome. PATIENTS AND METHODS: The subjects included in the study were three patients of our institution and 24 patients found in the revision of the English and Spanish pediatric literature who fulfilled the diagnostic criteria of ophtalmoplegia-ataxia-areflexia syndrome. The topographical location of the lesion in the nervous system was based on previously established criteria by using clinical and complementary studies. RESULTS: Of the 27 patients included in the study we were able to reach an accurate topographical diagnosis in 9. None had an exclusive involvement of the peripheral nervous system, (6) had exclusively central nervous system involvement and 2 showed involvement of both system. In 12, the topographical location of the lesion could be only ascertained as probable; 3 of them in the peripheral nervous system, 2 in the central nervous system and mixed involvement in 7. In the remaining 7 patients there were insufficient clinical data to allow topographical classification. CONCLUSIONS: The ophtalmoplegia-ataxia-areflexia syndrome can also be found in pediatric patients. The lesion in the majority of patients in this age group is located in the central nervous system, either alone or combined with peripheral nervous system involvement.     

Metaphor: A review of the psychological literature.

Maintains that metaphor supplies a language with flexibility, expressibility, and a method by which to expand; it also contributes to the functioning of cognition, language, memory, and creativity. Learning and mediational theories account for metaphor creation on a sensory basis (a) as an example of mediation by physical similarity between stimuli or (b) by response similarity between different empirical modes. Nativistic theories posit internally based processes such as physiognomic perception or intersensory characteristics of individual sense modalities. A nonconscious basis of metaphor is postulated by psychodynamic theories. In addition to inexperience with the weaker normal aspect of word meaning, syncretism and physiognomic perception might partially account for younger children's relative concreteness in comprehension. However, recent studies suggest that comprehension and production of rudimentary forms of metaphor appear in early childhood. Given the scarcity of systematic investigation, it is not clear whether metaphor is a special form of response or whether it can be subsumed under a general psychological theory, such as learning, cognitive development, or psychoanalysis. (89 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)