Antiparkinsonian drug abuse: eight case reports

Although abuse of antiparkinsonian drugs has rarely been reported in this country, there is evidence that it is more widespread than has generally been believed. The author reports eight cases in which abuse of the drugs was suspected. He emphasizes the need for increased awareness among physicians of the potential for abuse of antiparkinsonian agents and greater caution in prescribing them.     

Foreign-body abscesses presenting as soft-tissue tumours: two case reports

Green function analysis of the Fokker-Planck equation was used to describe protein conformational motion for approximate variational derivation of typical rate constant of protein relaxation from excited nonequilibrium state to the equilibrium. This approach was illustrated on a simple one-dimensional conformational potential.     

Successful removal of large pineal region meningiomas: two case reports

BACKGROUND: Pineal region meningiomas are extremely rare tumors and comprise about 8% of tumors of this region. Two cases of large pineal region meningiomas in young males are presented. METHODS: Computed tomography (CT) scan and cerebral angiography were used to evaluate the patients preoperatively. Both patients were operated on through an occipital transtentorial approach either as a single- or two-stage procedure. RESULTS: Preoperative work-up revealed that both tumors received their main blood supply from the posterior lateral choroidal arteries and were therefore originating from the velum interpositum cerebri (superior tela choroidea). Complete tumor removal was effected in the first patient using a right occipital transtentorial approach. In the second patient, after partial removal using the same approach, complete resection was achieved at a second stage via the left occipital transtentorial approach 3 months later. CONCLUSION: Cerebral angiography, which must include vertebral angiography, is important in the preoperative surgical planning of these tumors. The occipital transtentorial approach provides good access. However, a two-stage procedure using right and left sides may be necessary for large meningiomas receiving a bilateral blood supply from both posterior lateral choroidal arteries. Diagnosis, the surgical approach, and methods of tumor excision are discussed.     

Crohn's disease presenting as pyogenic liver abscess with review of previous case reports

A 40-yr-old male doctor from India presented with pyogenic liver abscesses as the first manifestation of Crohn's disease. The Crohn's disease itself was limited to the appendix and the adjacent cecum and could be diagnosed only 6 months after the presentation with liver abscess. This single case highlights three unusual features of Crohn's disease, and stresses the importance of meticulous search for a cause for pyogenic liver abscess when it occurs in an otherwise healthy adult.     

Benign esophageal stricture caused by diffuse severe esophagitis presenting as ascending fibrosis: report of a case

It is generally accepted that replanted digits surviving at least 1 week following surgery rarely succumb to ischemic necrosis. Presented here are 2 patients who experienced late digital replantation failure. The first patient is an 8-year-old boy who had his index finger replanted at the proximal phalangeal level. After 16 days of viability, the replanted digit became swollen and subsequently necrosed. The second patient is a 35-year-old man with a history of smoking and intravenous drug use who underwent replantation of his avulsed thumb at the metacarpophalangeal joint. The replanted thumb was viable at the 2-week follow-up, but began to show ischemic changes at 3 weeks and eventually required revision amputation at the interphalangeal level. Both of these patients demonstrate late digital replantation failure--an unusual and poorly understood phenomenon. A discussion of possible risk factors and potential pathophysiology is presented.     

Leiomyosarcoma of the small intestines: case reports

Intestinal malignant neoplasms are extremely rare (1% of all solid tumours) and leiomyosarcomas represent 20% of them. The authors report the experience of 5 cases (M:F ratio = 0.6), aged 30-69 yrs old, treated in the period 1985-95. The best results have been obtained in 2 cases, characterized by low grading and submitted to curative resections. The others presented local and distant (mostly hepatic) extensions with a poorer prognosis (1-3 yrs. survival). Leiomyosarcomas are particularly binding because of their rarity and aspecific symptomatology, determining late diagnosis in most cases. The clinical course, the surgical and complementary management, the istology and the prognosis have been analysed. Nowadays 5 yrs-survival is very low and the prognosis remains severe because of local and distant metastases, already present at laparotomy. New chances may come out from better diagnostic techniques and from new complementary chemotherapeutical associations.     

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.     

A follow-up of rhabdomyosarcoma of the infratemporal fossa region in adults based on the magnetic resonance imaging findings: case reports

Two adult patients with rhabdomyosarcoma of the infratemporal fossa region were evaluated by computed tomography and magnetic resonance imaging both before and after treatment. Successful treatment accompanied by reduction of the tumor mass as a result of chemotherapy was demonstrated in one patient. In the other patient a subsequent increase in the tumor mass was documented. Information on not only the size but also the internal architecture of the tumor may be useful when tumor response to therapy is being investigated. Magnetic resonance imaging is recommended as a method for outcomes evaluation in adult rhabdomyosarcoma cases.     

Benign metastasizing chondroblastoma: a case report

Treatment of interdigital tinea pedis often involves long-term therapy with topically applied preparations. Effective oral preparations, such as the allylamine terbinafine (Lamisil), taken over a shorter period, could provide a useful therapeutic alternative. A total of 269 patients from five centres with clinically diagnosed interdigital tinea pedis were entered into this double-blind, randomized, double-dummy, parallel-group study comparing oral terbinafine 250 mg once daily for 1 week with 1% clotrimazole (Canesten) cream applied twice daily for 4 weeks. Of these, 137 patients were evaluable for efficacy (confirmed dermatophyte infection by microscopy and culture): 63 terbinafine and 74 clotrimazole. At week 4, the mycological cure rates (negative culture at week 1 and negative results on microscopy and culture at week 4 onwards) were very similar (71% for clotrimazole and 72% for terbinafine). There was a faster response rate in the terbinafine group with respect to signs and symptoms at week 1. Both treatments were equally well tolerated; adverse events occurred equally in the two groups. In conclusion, oral terbinafine in a single daily dose of 250 mg for 1 week is as effective and as well tolerated as 1% clotrimazole cream applied twice daily for 4 weeks in the treatment of interdigital tinea pedis.     

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.     

Benign schwannoma of the breast: report of a case

We report herein the case of a 62-year-old woman who presented to our hospital for investigation of occasional pain in her left breast. Although there was no mass palpable in her left breast, mammography and ultrasonography revealed a round tumor in the upper outer quadrant of the right breast. Although the mammography findings indicated that the tumor was benign, the possibility of a malignant neoplasm could not be ruled out by the ultrasonographic images. A final diagnosis of schwannoma was established by histopathological examination of the excised mass.     

Upper esophageal stenosis: two case reports

Esophageal stenosis caused by an intrinsic congenital deformity is uncommon in infants and children. The main forms of stenosis are congenital esophageal web congenital stricture caused by tracheobronchial remnants, and congenital idiopathic muscular hypertrophy. The authors report on two patients who were successfully treated and managed after being diagnosed as having upper esophageal stenosis. One patient underwent resection of the web and primary anastomosis of the esophagus and was discharged 6 days after surgery. After 1 year, this patient has had no symptoms of dysphagia or other postoperative difficulties. The second patient underwent balloon dilatation of the esophageal stricture and was discharged on the day of surgery; however, this patient required numerous repeat dilatations.     

Correcting high anisometropia: two case reports

In the cases reported, the anisometropia had not been corrected previously. Despite the common belief that such a correction would induce intolerable symptoms in adults, both patients successfully adapted to the full correction within a few days, showing marked improvement in binocular vision skills.     

Depression after smoking cessation: case reports

BACKGROUND: Cigarette smokers with a history of major depression are at risk for developing depressive mood when they attempt cessation. Whether cessation can also provoke more severe depressions, however, has not been well documented. METHOD: Six case reports of severe depressive episodes after smoking cessation are described. RESULTS: Four cases occurred among smokers with a history of major depression but who were not depressed at the time of cessation. Two cases involved smokers with no previous history of major depression. Variability in both the timing and the outcome of the postcessation depressions was observed. CONCLUSION: The risk that depressive states may emerge or be exacerbated after smoking cessation, particularly in patients with a history of major depression, must be kept in mind in the treatment of nicotine dependence.     

Acute traumatic abdominal hernia: case reports

Traumatic abdominal hernia is a rare injury with most reports documenting only one or two such cases. We describe five cases that were recognized during a 22-year period at a single trauma center. Physical examination often revealed abdominal wall tenderness and ecchymosis, but confirmation of hernia required additional testing in four of five patients. Two patients sustained muscle avulsion from the iliac crest which was likely a result of obesity and high riding seatbelts. In three of the patients a computed tomographic scan of the abdomen was instrumental in making the diagnosis. Surgical repair of the hernia was accomplished in three patients. The other two patients were managed nonsurgically. This report documents that an individualized approach to these patients is appropriate. Diagnosis may be difficult and immediate surgery does not prevent late sequelae. Management guidelines based upon a review of the English language literature on traumatic abdominal wall hernias are presented.