Pancreatic tuberculosis in non-immunocompromised patients: reports of two cases, and a literature review

We present two cases of biopsy proven tuberculosis of the pancreas in non-immunocompromised patients diagnosed and treated in our unit within the last 14 years. The first case presented with abdominal pain and fever, and the second with iron deficiency anaemia and severe weight loss. In both cases abdominal ultrasound and computed tomography suggested a pancreatic carcinoma. There was no pulmonary or intestinal tuberculosis. The tuberculin skin test was positive. Upon exploratory laparotomy the macroscopic appearance of the pancreas was that of an inoperable pancreatic carcinoma. Following the histological diagnosis of pancreatic tuberculosis, both patients were successfully treated with triple antituberculous therapy for 6 months. Isolated pancreatic tuberculosis is an extremely rare disease with only 41 cases in non-immunocompromised patients reported worldwide (1966-1997). It is a curable disease and should be considered in the differential diagnosis of a pancreatic mass or abscess shown on ultrasound or computed tomography, especially in developing countries, where tuberculosis is common.     

Disseminated acanthamoeba infection in patients with AIDS: case reports and review

Acanthamoeba infection has been described as an opportunistic infection in persons with AIDS. We report two cases of patients with AIDS and acanthamoeba infection and review the manifestations of this protozoan infection in patients infected with human immunodeficiency virus. The diagnosis of this infection requires a high index of suspicion because the clinical and histologic manifestations may be confused with those of disseminated fungal or algal disease. Clinicians and laboratory personnel should be aware of this potentially fatal condition so that appropriate diagnostic studies can be performed and treatment can be urgently administered. Early initiation of therapy may alter the clinical outcome of the disease.     

Disseminated histoplasmosis associated with disseminated tuberculosis: a case report

Disseminated histoplasmosis is reported in a 70-year-old White man. There was also evidence of a previous disseminated tuberculosis infection. This is the 9th reported case of disseminated histoplasmosis in the Republic of South Africa.     

The overlooked blunt component in penetrating neck injuries: three case reports

Three cases of penetrating neck injury associated with an unsuspected blunt carotid injury are reported. Attention is drawn to the possibility of this rare association, that can cause irreversible damage, if overlooked. Early angiogram and possibly duplex Doppler scanning are warranted to prevent neurologic sequelae.     

Disseminated tuberculosis of unusual locations

We report a case of disseminated tuberculosis involving the middle ear, the central nervous system, the spine and the lung. The tuberculous epidural abscess and otomastoiditis don't have any specific imaging features. But their coexistence with an other tuberculous involvement might suggest their tuberculous nature. The epidural abscess may result from direct extension from otomastoiditis.     

Cyanotic Raynaud's phenomenon with conventional but not with liposomal amphotericin B: three case reports

Despite its common adverse effects intravenous (i.v.) amphotericin B is an indispensable antifungal drug in childhood oncology. We report here on three cases of painful cyanotic Raynaud's phenomenon after i.v. administration or inhalation of amphotericin B. A liposomal i.v. preparation of amphotericin B was well tolerated by the infants. Spasms of peripheral vessels mediated by thromboxane A2 could be responsible for the Raynaud's phenomenon. Hence, inhibitors of prostaglandin synthesis are suggested for therapy.     

Hepatitis associated with terbinafine therapy: three case reports and a review of the literature

Single-rooted premolar teeth, stained with blood utilizing the technique devised by Freccia & Peters (1981), were subjected to traditional and non-peroxide bleaching agents. Colour changes were recorded over a period of 7 days using a Speedmaster R75-CP Reflection Densitometer. The most efficient removal of staining occurred after the application of 30% hydrogen peroxide, with sodium perborate being 75% as effective. All bleaching agents realized their optimum efficacy within the first 3 days. A combination of three enzymes (amylase, lipase and trypsin) with disodium edetate was not as effective as the routine bleaching agents; however, the combination did have a modifying effect on the blood stains. It is suggested that other non-peroxide agents should be investigated to determine their efficacy in removing staining from experimentally induced blood-stained teeth.     

High-dose chemotherapy and autologous transplantation in lymphomatous polyposis in second remission: three case reports and literature review

AM-1155, a novel fluoroquinolone, exhibited potent activity against Streptococcus pneumoniae, including penicillin-resistant strains; the MIC90 for 48 clinical isolates was 0.25 mg/L. The antibacterial activity of AM-1155 against S. pneumoniae was higher than that of levofloxacin (MIC90 1 mg/L) and comparable with that of sparfloxacin. The MIC90s of penicillin G and erythromycin were 2 and > 4 mg/L, respectively. AM-1155 showed no cross-resistance to penicillin or erythromycin. For experimental murine pneumonia with S. pneumoniae intermediately resistant to penicillin, oral administration of AM-1155 showed efficacy higher than that of levofloxacin and equal to that of sparfloxacin. The efficacy of AM-1155 was also equal to that of subcutaneous penicillin G administration at the same dosage.     

Warfarin--topical salicylate interactions: case reports

This paper deals with two patients on warfarin in whom the use of topical methylsalicylate preparations led to clinically significant bleeding problems. The first patient required fresh frozen plasma to tide over the crisis while the second patient recovered spontaneously on stopping the warfarin temporarily. The possible mechanisms by which salicylates potentiate the anticoagulant effect of warfarin are briefly outlined.     

Pediatric contact lenses: case reports

BACKGROUND: Contact lenses may be a useful, even essential, treatment modality for children with a variety of optometric needs. Many clinicians who are experienced and capable contact lens practitioners but do not specialize in the care of children may refrain from considering contact lenses as a treatment option because of a host of perceived problems. Most of these concerns can be readily overcome with patience, planning, and education. CASE REPORTS: Five cases are presented to illustrate specific clinical problems and the clinical application of contact lenses in the pediatric population. CONCLUSION: The case reports illustrate the clinical application of contact lens fitting in children with a variety of clinical needs. The use of contact lenses in children is an ongoing process, requiring great flexibility and creativity on the part of the optometrist. Educating the child and the family is an integral part of the treatment. The use of contact lenses in children is both an opportunity and a challenge that may result in great satisfaction for the child, the family, and the optometrist.     

Fundic gland polyps: three other case reports suggesting a possible association with acid suppressing therapy

Image analysis technique was used to measure four parameters [the form factor (FF), area, perimeter and diameter] of nuclei in 76 cases of common intracranial tumors on forzen and paraffined slices. The results showed that the area, perimeter, diameter of nuclei on frozen slices were much larger than those on paraffined slices while the FF showed no significant difference between two kinds of slices (P > 0.05). The parameters of the area, perimeter, and diameter of nuclei on two kinds of slices became larger and the parameters of FF became smaller as the grade of astrocytoma ascended. It is considered that the results of present study will be helpful to the diagnosis of common intracranial tumors on frozen slices.     

Laparoscopic vesicoureteroplasty in children: initial case reports

The effects of 5 different growth factors [EGF, PDGF(bb), TGF-alpha, bFGF and IL-2] were studied on tumour spheroids obtained from 5 different human glioma cell lines (U-251MG, D-263MG, D-37MG, D-54MG, GaMG). The expression of EGF and PDGF receptors as well as the endogenous production of TGF-alpha and PDGF were studied by Northern blot analyses. After growth-factor-exposure, tumour spheroid volume growth, and directional cell migration from the spheroids were studied. In addition, tumour-cell invasion was studied in vitro, where foetal rat-brain aggregates were used as a target for the tumour cells. In all the assays a common stimulator for most of the cell lines was EGF. The other growth factors had a more heterogeneous stimulatory effect. Tumour-cell invasion, cell growth and cell migration are biological properties which are not necessarily related to each other. This may explain why the tumours often responded differently to the growth factors in the various assay systems. Two of the cell lines studied were non-invasive (U-251MG, D-263MG). It is shown that these were stimulated both in the directional migration assay and in the spheroid-volume-growth assay. However, their non-invasive behaviour was not influenced by the growth factors studied.     

Chronic relapsing thrombotic thrombocytopenic purpura: three case reports and update of the pathogenesis and therapeutic modalities

Chronic relapsing thrombotic thrombocytopenic purpura (CRTTP) is the rarest type of TTP, usually presenting in childhood. The aetiology is still not fully explained. The disorder is associated with the presence in plasma of unusually large von Willebrand factor (UlvWF) multimers that are especially prominent between episodes. CRTTP can be prevented by periodic plasma transfusions. We report three children with congenital CRTTP who have been successfully treated and maintained in prolonged remission by the prophylactic use of fresh frozen plasma without concurrent plasmapheresis. Two of the patients are sibs.