Multiorgan changes in AIDS in a reported case

The clinical course of HIV infection and results of autopsy examination in 49 years old patient was shown. The attention was paid to difficulties of diagnosis of opportunistic infections in a patients with advanced HIV disease. Variety of infectious factors, that could affect a patient with significant immunodeficiency was outlined.     

Purulent pericarditis occurring in a patient with cecal carcinoma: report of a case

We report the unusual concatenation of cecal carcinoma complicated by bacteremia and purulent pericarditis. The organism responsible for the pericarditis was not definitely established. The pericarditis was successfully managed by surgical drainage and antibiotic therapy. Colonic surgery followed eradication of the pericarditis.     

A case report of jejunal carcinoma in a patient with tuberous sclerosis]

It remains uncertain if law enforcement officers experience an elevated cardiovascular disease morbidity and, if so, whether their profession contributes to this incidence. Consequently, the self-reported incidence of cardiovascular disease (CVD) (coronary heart disease, myocardial infarction, stroke, coronary artery bypass graft surgery, angioplasty) and CVD risk factors (age, diabetes, elevated body mass index (> or = 27.8 kg.m-2), hypercholesterolemia, hypertension, tobacco use) in 232 male retirees, > or = 55 years of age, from the Iowa Department of Public Safety were compared with 817 male Iowans of similar age. CVD incidence was higher in the law enforcement officers than the general population (31.5% vs 18.4%, P < 0.001). Using multiple logistic regression, factors found to be associated with CVD included the law enforcement profession (odds ratio [OR] = 2.34; 95% confidence interval [95% CI] = 1.5-3.6), hypercholesterolemia (OR = 2.37; 95% CI = 1.7-3.3); diabetes (OR = 2.22; 95% CI = 1.4-3.6), hypertension (OR = 1.79; 95% CI = 1.3-2.5), tobacco use (OR = 1.67; 95% CI = 1.07-2.6), and age (OR = 1.06; 95% CI = 1.03-1.08). These results suggest that employment as a law enforcement officer is associated with an increased cardiovascular disease morbidity and this relationship persists after considering several conventional risk factors.     

Carnosinemia. First French case

Serum high density lipoprotein (HDL) cholesterol, total serum cholesterol and triglycerides were determined in twenty men before, immediately after, and 1, 2 and 4 days after a 70 km cross-country ski race. HDL cholesterol increased by 12% of the pre-race level immediately after the race, rose further to 17% above the initial level on the following day, and was still elevated 4 days after the race. LDL + VLDL cholesterol, however, showed a tendency to decrease immediately after the race and was reduced by 17% and 11% of the pre-race level on the following 2 days. Triglycerides were reduced by 30% of the initial level immediately after the race, were still low on the following day, but were restored to normal 2 days after the race. It is concluded that a single exposure to prolonged heavy exercise induces changes in the HDL metabolism, showing that the physical exercise per se plays an important role for the increased HDL level seen in well-trained athletes.     

Squamous cell carcinoma of the gingiva in an HIV-positive patient: a case report

This article presents a case of gingival squamous cell carcinoma in a patient who was HIV positive but who had no history of pan chewing, smoking, alcohol consumption or nutritional deficiency. Investigations also revealed the presence of superimposed pseudomembranous candidiasis. The case reported reveals that squamous cell carcinoma of the gingiva may occur as an oral manifestation of AIDS.     

Wegener''s granulomatosis. First case report in Bahrain

PURPOSE: To consider and differentiate oedema fluid from other fluids in the performance of epidural block. CLINICAL FEATURES: A patient underwent placement of an epidural catheter for vaginal delivery of twins. Following a loss of resistance technique using air a small amount of fluid was aspirated through the needle and subsequently through the epidural catheter. The epidural block and delivery followed uneventfully. After delivery oedema fluid oozed from the puncture site for a number of days. Laboratory investigation revealed that this fluid was of oedematous origin. Bedside determination of alkaline pH by Combur 10 Test M urine stick appeared to be a simple and useful test for distinguishing the oedema fluid from fluids of other possible sources. CONCLUSION: When performing an epidural blockade the return of fluid may be due to oedematous fluid. Differentiation of the pH by a simple bedside test can aid in the differential diagnosis and prevent unnecessary additional attempts at needle repositioning.     

Embryonal carcinoma in a 16-year patient

The authors present diagnostic and therapeutic documentation of a very rare case of a tumour with carcinoma embryonal in a 16-year old girl. After the surgery (total hysterectomy and adnexectomy) followed by chemotherapy, the patient survived four years.     

Ocular adnexal oncocytoma: a case series and clinicopathologic review of the literature

OBJECTIVE: Headache is a common complaint in children and brain imaging has become widely used to evaluate this clinical condition. We studied the value of neuroimaging in children with chronic headaches. PATIENTS AND METHODS: A retrospective chart review was conducted of all children referred to the pediatric outpatient clinic for evaluation of headache over a 3-year period. The charts were reviewed for headache characteristics, clinical indications for performing neuroimaging, and imaging results. Special attention was paid to evidence of space-occupying lesions. RESULTS: A total of 160 records were studied, with subjects ranging in age from 4 to 14 years. Most patients were diagnosed as having migraine headaches (60%) or chronic tension headaches (29.5%). Other diagnoses were post-traumatic (6%) and unclassified (4%). Sixty-six patients (41%) had computed tomography imaging performed. In most cases, brain imaging studies were performed because of clinical data (41%) like atypical pattern, sleep-related headache or increase of headache, because of the parents' concerns about brain lesions (38%) and because of an age less than 5 years (14%). Structural changes were found on brain imaging in 4 patients, but none indicated the presence of a treatable space-occupying lesion and all were deemed unrelated to the headache. Our findings of no relevant abnormalities in a series of 66 neuroimaging studies indicate that the maximal rate at which such abnormalities might appear in this population is 4.4%. CONCLUSIONS: These results indicate that neuroimaging studies have very limited value in the clinical evaluation of pediatric patients with chronic headache and should be reserved for those patients with clinical evidence suggestive of underlying structural lesion.     

Clinical case of the month. Uremic pericarditis in a dialysed patient

Cultural strains of hepatitis A virus (HAV) have been isolated from spontaneously infected Macaca mulatta (HAV-MM), Papio hamadryas (HAV-PH), African green monkeys Cercopithecus aethiops (HAV-CA), and patients (HAV-H). The strains replicate in continuous cells lines AGMK, 4647, Vero, and FRhk-4. AGMK and 4647 cells are the most permissive at 32 degrees C. Virus propagation was not associated with the cytopathic effect and could be detected by enzyme immunoassay (EIA), immune electron microscopy (IEM), and molecular hybridization method (MHM). The morphological and antigenic properties of the above monkey and human strains did not differ in EIA and IEM with polyclonal antibodies and for one most conservative genome sites in the VP1 domain. Cultural strains retained their pathogenicity for monkeys. HAV strains are proposed to be used as HAV antigen in immunological tests and for hepatitis A induction in monkeys.     

Pneumococcal pneumonia in a patient with HIV infection. Development to excavation. Apropos of a case

Three hepatitis A virus (HAV) strains (L8, H32 and H52) were isolated from stool specimens of hepatitis A patients during an epidemic in 1988 in Shanghai and were adapted to grow in human diploid fibroblast cell strain (KMB17). The strains were serially carried through 10 passages in KMB17. The infectious titrations of these virus strains cultured for 28 days at the 10th passage were high up to 7.0-7.75 log TCID50/ml. The maximum virus yields occured in the 28th day after infection. Immune electronic microscopic studies revealed that the viral particles were 27-30 nm in diameter. The strains were neutralized by specific anti-HAV serum. Special fluorescent stained particles were observed clearly in the infected cellular plasma by direct IF. The above data suggest that the three strains are HAV and may be useful for further study.     

Acromesomelic dwarfism: description of a patient and comparison with previously reported cases

SPF-male rats were treated intraperitoneally with phenobarbital (30 mg/kg/day) or 0.9% sodium chloride for 4 days. Endogenous creatinine clearance in conscious rats and inulin clearance in nondiuretic rats under inactin anesthesia were measured 24 hr following the last injection. In an additional group of treated rats diuresis was induced by sodium chloride and mannitol and then inulin- and PAH clearance were measured simultaneously. Following 4 days treatment with phenobarbital, endogenous creatinine clearance and inulin clearance were not significantly different in control and phenobarbital-treated animals. In contrast significant changes were found in urine volume and PAH clearance in the phenobarbital-treated animals. These results do not reflect any change in glomerular filtration rate, but might be attributed to an increase in renal plasma flow or an activated tubular transport system following phenobarbital administration.     

Clinical case of the month. Apropos of pancytopenia in a seropositive patient

A 37-year old patient, HIV-1-infected, consulted for progressive weakness and dyspnea on exertion, increasing over three months. Complete blood count showed pancytopenia, while the bone marrow revealed severe hypoplasia. Other investigations, including serology for CMV, vitamin levels, Coombs test, gastroscopy and colonoscopy were non contributing. A diagnosis of zidovudine-induced medullary aplasia was made; the clinical course was favourable after this drug was replaced by triple therapy. The authors discuss the differential diagnosis of cytopenias in the patient infected by HIV and they suggest a diagnostic approach.     

Spontaneous rupture of pheochromocytoma in a patient with polycystic kidneys. Apropos of a case

OBJECTIVE: To report a case of spontaneous rupture of adrenal pheochromocytoma. METHODS/RESULTS: A patient previously diagnosed as having arterial hypertension and chronic renal failure secondary to adult polycystic renal disease was admitted to the emergency services with abdominal pain, signs of peripheral vasoconstriction and syncope. A CT scan showed a large perirenal hematoma. The patient underwent an extended left radical nephrectomy and evacuation of the hematoma. The histopathological analysis showed a polycystic kidney and a ruptura adrenal pheochromocytoma. The clinical features, diagnosis and treatment of this condition are discussed.     

Variations in the reported age of a patient: A source of bias in the diagnosis of depression and dementia.

The presence of bias in assessing organic vs depressive pathology in the elderly psychiatric population has been clinically observed in the apparent tendency to overattribute cognitive deficits to senile dementia. In the present study, 21 male and 15 female 26–49 yr old clinical psychologists were presented with a taped interview in which the age of a 64-yr-old male with depressive pseudodementia was varied (either 55 or 75 yrs). It was assumed that the ambiguity involved in determining the etiology of the patient's cognitive deficits would elicit a social or diagnostic bias related to his age. Results show the presence of a bias, with a greater attribution of organic symptoms reflective of senile dementia and fewer judgments of depression when the patient was described as elderly rather than middle-aged. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)