The hazard of persistent cigarette smoking in later life

Two cases of post-traumatic syringomyelia studied macro- and microscopically are reported and compared with three previous autopsy cases described in the literature reviewed. The histological findings suggest that the pathogenesis may be explained by a pressure gradient in a small primary cavity. Although syringomyelia is a rare complication of traumatic spinal cord lesions, it is important to draw attention to the condition because it may be improved by surgical intervention.     

Autism and known medical conditions: myth and substance

There is general agreement that autism has an organic basis but there is less agreement on the frequency with which it is associated with known medical conditions. The evidence in the literature on the latter point is reviewed and it is concluded that the rate of known medical conditions in autism is probably about 10%; however the rate appears to be higher in cases of autism associated with profound mental retardation and in cases of atypical autism.     

Evaluation of autofluorescence as an aid to diagnosis of cerebrocortical necrosis

A series of brains from sheep, cattle, goats and pigs was examined histopathologically and illuminated by ultraviolet light to test the specificity of autofluorescence in the diagnosis of cerebrocortical necrosis. Fluorescence was seen in only four cases of porcine encephalopathy. In the ruminant brains it occurred in seven out of eight cases of cerebral oedema of lambs; otherwise it was confined to cases of cerebrocortical necrosis, although a few false negative cases were encountered. Ovine cerebral oedema is a disease of unweaned lambs which is unlikely to be confused with cerebrocortical necrosis. Thus bright cerebrocortical autofluorescence in a naturally occurring disease of cattle, sheep and goats is a likely indicator of cerebrocortical necrosis; however, a small proportion of cases will escape detection by this method.     

Reactivation of hepatitis B after transplantation in patients with pre-existing anti-hepatitis B surface antigen antibodies: report on three cases and review of the literature

The authors report the case of a 34 year old woman, admitted to hospital because of myocardial infarction two months after delivery of her fifth child. The infarction was caused by spontaneous dissection of the left main coronary and left anterior descending arteries. Twenty-three months later, the patient was well with medical therapy. This case is an example of spontaneous post-partum coronary dissection which is the commonest cause of infarction occurring in that period. The physiopathology of this complication is not fully understood. The prognosis is poor, lethal in two thirds of cases. However, it must be emphasised that coronary dissection may regress spontaneously. Patients were previously referred systematically for surgery, but now it is usually reserved for cases with persistent myocardial ischaemia despite medical therapy. Angioplasty may be preferred despite the risks and may be successful in some cases.     

Value of scaphal graft in secondary rhinoplasties

The scaphal cartilaginous area is a most suitable anatomic site for cartilaginous graft harvesting. These grafts allow reconstruction of a flat dorsum, or a rounded dome, or alar cartilages or can be used for an extended tip graft. In some cases, both scaphes may be harvested. Raising of the grafts does not leave any sequelae when performed correctly. We have an experience of 20 cases. The main advantage of this graft is its flatness, which makes it ideal for the nasal dorsum. It has to be tailored, moderately crushed and included in a collagen "surgicel" in order to break the shape memory, slightly curved at its borders. We have used scaphal autografts in 15 cases of secondary rhinoplasties, 2 cases of cleft lip repair and in 3 cases of tertiary rhinoplasties. They solved most problems of missing cartilage, when minor defects had to be treated. These grafts will not solve major tissue defects which must be repaired by bone autografts, mostly iliac bone harvesting in our experience. The results of scaphal autografts are stable after 5 years. Resorption is moderate when the graft is correctly inserted, in an extramucosal pocket. The aesthetic result is maintained with a mean follow up of 2 years for 15 cases. The scaphal area of the ear therefore appears to be a favorable donor site for secondary, nose repair; it is easy to harvest, with inconspicuous morbidity and allows the raising of a good, flat and sculpturable material for cartilaginous nose replacement. Achieves the objectives of ore informed patients asking for artistic perfection.     

Polypoid ulcerating endocarditis aortalis caused by Streptococcus viridans with perforation of the right atrium. Pathology and clinical aspects of 2 autopsy cases

We report two cases of patients (one 65 and one 43 years of age, respectively) who died of Streptococcus-viridans induced endocarditis of the aortic valve with perforation into the right atrium. Whereas perforation in Staphylococcus-induced endocarditis is a common complication, it occurs rarely in Streptococcus-induced endocarditis. Because of its uncharacteristic symptoms, the endocarditis was clinically unknown in both cases and was recognized to be the cause of death only at autopsy. To reduce the large number of complications in patients suffering from endocarditis, it is necessary to confirm the diagnosis as soon as possible if endocarditis might be suspected.     

Staging and surgery in testicular cancer

Both staging and surgery in testicular cancer are thoroughly analysed. Extensive experiences from various authors are reported and compared. The essentials for staging are suggested and a new detailed stage grouping is proposed. The role of surgery in diagnosis, staging and therapy is examined. It is stressed that in non-seminomas, retroperitoneal lymph node dissection is not only a staging procedure, but it may be also a curative operation in several cases of patients with lymph node metastases and a prospective randomized clinical trial is advocated in order to clarify the usefulness of adjunctive chemotherapy in these cases. Surgery is also useful as adjuvant to chemotherapy in several patients with advanced non-seminomas and it is underlined that it should be undertaken early, after only 2 or 3 cycles of chemotherapy, in order to avoid the strong fibrosis that often occurs after long-term chemotherapy and which makes surgical dissection very difficult or even impossible. Lastly, even if extensive, surgery seems to be a safe procedure in these young patients.     

Plasma growth hormone concentrations during growth in turkeys

Cytology in malignant melanoma of the skin is a useful method, which alone yields in many cases enough diagnostic informations for a therapeutical approach. It is of a special importance in cases with marked anisocytosis of cells and with large, sometimes polynuclear cells and with cells with melanotic pigment. In cases with middle-sized apigmented cells of epitheloid appearance it should be always completed by biopsy, which, in these cases predominates over cytology. Combination of both methods brings a more substantial elucidation of diagnosis.     

Synthesis and biological activity studies of 3-arylaminomethyl-7H-6-(6 substituted-3-coumarino)-S-triazolo-[3,4-b][1,3,4]thiadiazines

Sarcoidosis (S) is a systemic disease affecting above all lymph nodes and lung tissue. Skeletal involvement is reported to occur in 14% of patients, the most common manifestations is cystoid osteitis, an asymptomatic lesion localized to the small bones of hand and feet. Lytic lesions are rare and usually accompanied by visceral involvement, the lesions may be detected in vertebral bodies and in long bones, pelvis and scapulae. MRI may be a good diagnostic tool, but open biopsy is often necessary. Joints are involved in about 89% of patients with acute sarcoidosis. Arthritis is localized more frequently to knees and ankles, is polyarticular, a little painful, migratory and transient, often accompanied by erythema nodosum. Clinical manifestations disappear in a few weeks, chronic and erosive disease is rare and always associated with systemic involvement. In these patients it may be useful to perform gallium citrate 67 scintigram and evaluation of serum ACE. Synovial biopsy lacks of specificity and sensibility, and in some cases it is necessary to perform open biopsy. S is a disease that may spontaneously regress and therapy may be unnecessary. In some cases, methotrexate may be useful in addition to prednisone. Chloroquine and hydroxychloroquine are effective in cases of skeletal involvement.     

Murine Pkd1 introns 21 and 22 lack the extreme polypyrimidine bias present in human PKD1

Restorative proctocolectomy with ileal pouch-anal anastamosis (IPAA) is the operation of choice to avoid permanent ileostomy in the surgical management of patients with ulcerative colitis and familial adenomatous polyposis coli. IPAA with two loops of small intestine (J-pouch) is the most common configuration. Mortality rates are low, and despite significant morbidity patient satisfaction remains high. Functional results are good in most cases. We present two cases of hydronephrosis following IPAA. Loin pain was the presenting symptom in both cases, with one patient developing impaired renal function. Hydronephrosis has not been reported following IPAA, but with other forms of pelvic and retroperitoneal surgery it is believed to remain largely asymptomatic. We discuss the etiology of this previously unrecognized complication and suggest that it may be more prevalent following IPAA than is realized.     

Cervico-mediastinal recurrences of differentiated thyroid cancers: value of MRI

AIM: The aim of this study was to evaluate the ability of MRI to detect recurrent differentiated thyroid carcinomas developed in the neck or the upper mediastinum. RESULTS: MRI was performed in 25 patients, and was compared in 5 cases with surgery. In 20 cases it was compared with I-131 scintigraphy (100 mCi in 14 cases and 5 mCi in 6 cases). The sensibility, specificity and overall accuracy of MRI was respectively: 100%, 66.6%, 82.6%. COMMENTARY: MRI is a good technique to detect recurrent thyroid carcinomas. It is specially interesting to investigate patients with a biological suspicion of recurrence and a negative scintigraphy. Mediastinal localisations that cannot be detected by US can be detected by MRI.     

Appendicular skeletal muscle mass: prediction from multiple frequency segmental bioimpedance analysis

The presence of Helicobacter pylori (H. pylori) in the stomach is closely associated with histological signs of chronic active gastritis and peptic ulcer. Another spiral organism named Gastrospirillum hominis (G. hominis) has led to further interest in the bacterial pathogenesis of gastritis. Due to the low prevalence of G. hominis, it is difficult to evaluate its biological behavior. Recently 16 cases of G. hominis-associated gastritis were found in 257 Thai individuals, which made it possible to study the biological characteristics of G. hominis and its relationship with gastric mucosal inflammation. The results showed that H. pylori and G. hominis could be easily observed in the lower third of the mucous layer and in the mucosa of the gastric pits by means of toluidine blue staining. Both bacteria immunostained positive. Helicobacter pylori were usually in the shape of curved bacillary while G. hominis often appeared in spiral configuration. In 257 cases of Thai subjects, 169 cases were found to be H. pylori positive, the detection rate was 65.7%, and 16 cases were G. hominis positive, with a 6.2% detection rate. In G. hominis infection, 43.6% of cases had normal gastric mucosa. Superficial, erosive and atrophic gastritis cases were 13.2, 10.9 and 12.5%, respectively. Mucosal inflammation was usually severe in H. pylori, but neutrophil polymorph infiltration was often mild and focal in G. hominis infection. Although no G. hominis infection with carcinoma was shown in our cases, the occurrence of mucosal atrophy, metaplasia and dysplasia was higher in both bacterial infections compared with H. pylori- and G. hominis-negative cases. It is suggested that G. hominis may be partly responsible for the mucosal inflammation and some malignant-associated lesions.     

Renal insufficiency after intravenous immune globulin therapy: a report of two cases and an analysis of the literature

Over the past decade, intravenous immune globulin therapy (IVIG) has gained widespread use for a variety of clinical disorders. IVIG treatment is associated with a number of complications, including acute renal failure (ARF). Although the cause of IVIG-associated ARF is unknown, it may be related to the stabilizing agent used in the IVIG preparation. The development and resolution of ARF is typically rapid, but is some cases recovery may be delayed and require renal replacement therapy. In such patients, recurrence of ARF may be avoided by selection of a preparation with a different stabilizing agent. Two cases of IVIG-induced ARF are described, and all reported cases are analyzed to assess the probable mechanism of renal injury.     

Pneumatosis cystoides intestinalis following intestinal bypass

Two cases of pneumatosis cystoides intestinalis occurring in the bypassed small bowel following intestinal bypass are presented. These cases and the recent recording of four others in the literature indicate this may be a common association. Etiology of the pneumatosis is unknown, but it is probably related to fecal reflux into defunctionalized bowel with the attendant alteration of bacterial flora.     

Percutaneous drainage of pancreatic necrosis: is it ecstasy or agony?

The above comments are meant to help the reader further analyze the fine study of Freeny et al. [1]. To my knowledge, this is the first series to specifically define its patients correctly as having pure pancreatic necrosis. This work represents a thorough analysis of a difficult problem and points out how to treat these patients if one wants to be successful. This template is important to radiologists who wish to get involved with this type of patient. What Freeny et al. truly describe is the agony and ecstasy involved with this difficult undertaking. Radiologists can obtain a lot of satisfaction in taking care of this type of patient, but they and the referring physicians must be committed. The patient, the referring physician, and the radiologist must also face the agony in dealing with the illness. They must be ready to handle the number of catheters, the number of catheter changes, the number of CT scans, and the duration of drainage. In some cases percutaneous drainage will work; in some cases it is the only alternative for a patient with this disease. In other cases a catheter or two can be placed, but they might not be as beneficial to the patient as surgery. Clearly, percutaneous drainage of pancreatic necrosis can be done, and radiologists must work with their clinical colleagues to decide whether it is in the patient's best interest.     

Invagination of the vermiform appendix. A report of two cases associated with endometriosis

Two cases of invagination of the Vermiform appendix associated with endometriosis are presented. Classification, incidence, etiology, symptomatology, diagnosis and treatment are discussed. The literature is reviewed in brief, and it is concluded that the possibility of invagination of the Vermiform appendix should be considered in obsure abdominal cases with recurrent right lower quadrant pain.     

Current status of treatment for small hepatocellular carcinoma

In recent years ethanol injection therapy (PEI) and transcatheter hepatic arterial embolization (TAE) have come to be widely used in the treatment of small hepatocellular carcinoma, and the introduction of microwave coagulation therapy (MCT) more recently has made it possible to perform a variety of non-surgical treatments even in cases in which surgical resection has been indicated until now. There have also been reports based on survival rates that results comparable to those obtained by surgical resection can be achieved with non-surgical methods. The main issue is whether PEI or resection should be selected to treat small hepatocellular carcinomas. However, the recurrence rate after PEI is higher than after surgical resection, and according to our results, in patients with solitary lesions, especially when the tumor diameter is 2 cm or less, the level of malignancy in many cases is also low biologically, and postoperative survival rates (recurrence-free survival rates) are favorable [5 years : 85.0% (64.3%); 10 years: 67.9% (42.2%)]. After thoroughly evaluating liver function in these cases, while surgical resection should be considered first, it is also important to use a combination of various treatment methods rather than always resort to a single method.     

Treatment of multi drug resistant tuberculosis

Multi drug resistant pulmonary Tuberculosis (MDR-TB) are divided into two types. The one is primary drug resistance and the other is acquired drug resistance. Cases of acquired MDR-TB are more often. Chemotherapy of MDR-TB demands use in combination of three or more sensitive anti-tuberculosis drugs, but it is difficult to apply this combined treatment practically. In Japan, it is often effective to use in combination of sensitive anti-tuberculosis drugs added PZA, Newquinolon agents and Clarithromycin. When chemotherapy is not effective, surgical treatment should be performed. We experienced six operation cases of MDR-TB. Lobectomy were performed in five cases, and all cases were negative tuberculous bacilli after operation. One case of thoracic empyema with bronchial fistula was positive tuberculous bacilli after operation and died of MDR tuberculosis.     

一种用于降低变异测试代价的新技术

针对变异测试代价大、无法广泛应用的问题,提出了一种在变异测试过程中引进测试用例选择以降低测试代价的方法.通过为每个变异体选择一定数量的测试用例,约束变异体允许执行的最大次数,从而减少无用功.测试用例的选择与变异体的变异程度相关,变异距离是描述源程序和变异体之间差异程度的指标,能够衡量测试集中有效测试用例的比例,进而指导测试用例的选择.距离越大,意味着变异体越容易被杀死,对应的有效测试用例则越多.实验结果表明该方法在不影响测试效果的情况下,可以明显降低变异测试的执行成本.     

Patellectomy after fracture. Long-term follow-up results with special reference to functional disability

Six cases are reported, in which an excision of the ciliary-body has been performed: 5 cases with secondary closed-angle glaucoma, and one case with secondary open-angle glaucoma. All eyes were aphakic, and in all cases other surgical interventions preceded. The ciliary-body excision is the easiest exactly doseable procedure, compared with other procedures regarding the ciliary-body. Usually excision of the ciliary-body represents the last choice to offer, however in selected cases it might be the method of choice. In this aspect our results are encouraging. The technical details of this procedure are described.