Primitive neuroectodermal tumor of the kidney--another enigma: a pathologic, immunohistochemical, and molecular diagnostic study

Two patients with presumed encephalitis lethargica are presented with clinical features suggestive of two forms of the disease described by Von Economo: One patient had a psychosis and a mute-akinetic syndrome associated with myoclonus. The second patient presented with a psychosis and fever, developing severe dyskinesias involving the mouth, trunk and limbs, together with respiratory irregularities and presumed hypothalamic disturbance and disturbance of consciousness. In both cases, initial cerebrospinal fluid (CSF) examination revealed an elevated white cell count (predominantly lymphocytes), elevated protein in case 2, and oligoclonal bands in both cases. Computed tomography (CT) brain scan was normal but in both cases EEG revealed diffuse slow wave activity. A 18F-Dopa positron emission tomography (PET) scan in case 2 was normal. The medical management of both patients is discussed. In case 1, L-Dopa improved the akinesia, while the myoclonus responded to clonazepam. In case 2, the severe dyskinesias failed to respond to a number of drugs, and she ultimately required paralysis to relieve her almost continuous movements. Both patients responded rapidly and dramatically to intravenous methylprednisolone. We suggest that steroid treatment should be considered in the acute phase of patients with features suggestive of encephalitis lethargica.     

Identification of Ce-AF-6, a novel Caenorhabditis elegans protein, as a putative Ras effector

Three female patients with osteoarthrotic hips received total hip replacement arthroplasties after failed rotational acetabular osteotomies (RAO) were reported. In the first case, there was necrosis of the thin acetabular fragment and a collapse of the large grafted iliac bone because of technical problems. The second case had residual development dislocation of the hip preoperatively which resulted in pseudoarthrosis and instability of the pubic bone postoperatively. This patient was considered to be a bad candidate for rotational acetabular osteotomy. The last case was 65 years old, too old to treat by osteotomy. Deterioration of the articular cartilage was expected. All of them were successfully treated with total hip arthroplasties. The ages of the patients, the stage of osteoarthrosis, the thickness of the osteotomized acetabular fragment, and the size of the grafted bone seemed to be factors influencing the outcome of the RAO.     

Epidural anaesthesia, ephedrine and phenylephrine in a patient taking moclobemide, a new monoamine oxidase inhibitor

We report a case of low thoracic epidural and general anaesthesia in a patient receiving moclobemide, a new selective inhibitor of monoamine oxidase A. Intra-operative hypotension was initially treated with phenylephrine and then with ephedrine. The short half-life of moclobemide and its modest interaction with direct and indirect acting sympathomimetic drugs permit the use of epidural anaesthesia, since any associated hypotension can be safely treated.     

Bifid scrotum, perineal hamartoma and high imperforate anus: a case report

This is a case report of a newborn patient with imperforate anus, urethro-colonic fistula, perianal hamartoma, and bifid scrotum. Successful staged repair of these anomalies is described together with review of the embriology related to the case.     

Pregnancy complicated by diabetes mellitus, superimposed preeclampsia, and adult respiratory distress syndrome: a case study

Pregnancy complicated by insulin-dependent diabetes mellitus carries severe physiologic risks for both the mother and the fetus. This article presents a case study to illustrate disease progression through multiple systems and psychosocial complications associated with diabetes mellitus in pregnancy. The case study also illustrates the role of nursing interventions, the use of technology, and interdisciplinary collaboration in caring for the patient and her family.     

Risk of cerebral angiography in patients with subarachnoid hemorrhage, cerebral aneurysm, and arteriovenous malformation: a meta-analysis

OBJECTIVE: To evaluate the utility of "clinic room" case presentation in the ambulatory care setting. BACKGROUND: Neurology is increasingly an outpatient specialty. The transition from ward to clinic presents challenges for student and resident education. Interaction between attending physician and trainee is limited by busy patient schedules. New educational strategies must be developed to address the particular challenges of the outpatient clinic. One strategy to increase the quality and length of attending-trainee interaction is case presentation in the patient's presence. METHODS: The authors randomized 100 patients seen in an academic neuromuscular clinic to presentation in a conference room or clinic room. In the latter, all interaction between the trainee and attending occurred in the patient's presence. The attending recorded the time spent with the trainee and patient. The patient was asked to complete a survey and provide certain demographic information. RESULTS: The two groups were similar demographically. Time spent by the attending physician was similar between the two settings. Although there was no difference in patient satisfaction, those randomized to clinic room presentation were significantly more likely (p < 0.002) to feel their questions were answered adequately. There were trends toward these patients feeling less embarrassed, feeling that they were treated respectfully, and feeling that adequate time was spent with them. CONCLUSIONS: Although clinic room presentation does not save attending time, it allows for a more dynamic and intensive interaction among teacher, student, and patient.     

Impact of a CareMap and case management on patient satisfaction and staff satisfaction, collaboration, and autonomy

The purpose of this research was to evaluate the effect of a CareMap and nursing case management on patient satisfaction and staff job satisfaction, collaboration, and autonomy. The patients who had a CareMap and a nurse case manager were more satisfied with their care. The multidisciplinary staff who worked on the experimental unit had increased job satisfaction and nurses who applied and were selected for case management positions had higher levels of collaboration and increased autonomy. Multidisciplinary team members who developed the CareMap also had higher levels of collaboration than other multidisciplinary staff on the experimental unit and their job satisfaction with quality of care increased under this new care delivery system.     

Successful predilation of a resistant, heavily calcified lesion with cutting balloon for coronary stenting: a case report

Papillary fibroelastoma is a rare, benign cardiac tumor that can cause multiple emboli. We report herein a case of papillary fibroelastoma developing from the chordae of the tricuspid valve which was detected by echocardiography and confirmed by surgical resection. To our knowledge, this is only the fifth documented case of a tricuspid valve papillary fibroelastoma detected by echocardiography in a living patient.     

Chinese herb nephropathy is not a (dex)fenfluramine nephropathy but a serotonin nephropathy

We detail the case history of a patient with Stage I seminoma, who developed an elevated level of human chorionic gonadotrophin (hCG) while on follow-up. It transpired that the patient had injected himself with hCG several days before. This type of abuse has been documented, but this is the first reported case of it interfering with the follow-up of a patient with a germ cell tumour.     

Calgary Depression Scale for Schizophrenia: a study of the validity of a French-language version in a population of schizophrenic patients

A case report of outpatient maintenance electroconvulsive therapy (ECT) is presented in a patient with bipolar disorder type I refractory to conventional medication treatment but responsive to ECT. A cost comparison is made showing substantial savings when outpatient maintenance ECT is used in lieu of inpatient hospitalization with ECT. A detailed life chart illustrating multiple medication trials that failed to stabilize the patient accompanies the financial summary. This case highlights the advantages of outpatient maintenance ECT for bipolar depression particularly with regard to safety, efficacy, and significant health care cost reduction.     

Coexistence of 3 tumors of neural crest origin: neurofibroma, meningioma, and uveal malignant melanoma

OBJECTIVE: To describe the clinical findings in a patient who developed a neurofibroma, meningioma, and choroidal melanoma. METHODS: Clinical and histopathological findings of the case are reviewed and presented. RESULTS: The patient had a right superolateral periorbital neurofibroma, a right sphenoid wing meningioma, and a left choroidal juxtapapillary malignant melanoma. All 3 tumors are derived from neural crest cells. CONCLUSIONS: To our knowledge, this is the first report of a patient with this combination of 3 neural crest-derived tumors. This case is most appropriately classified as a complex neurocristopathy, a disorder involving the aberrant and pathological proliferation of multiple tissues derived from neural crest cells.     

Amrinone, a phosphodiesterase III inhibitor, and arachidonic acid metabolism in humans

A 59-year-old patient who had photorefractive keratectomy (PRK) to correct high unilateral myopia developed a progressive nuclear cataract. Phacoemulsification and intraocular lens (IOL) implantation were performed. However, determination of IOL power using automated keratometry and computerized videokeratography was not successful in this case of high axial myopia because of a decentered ablation zone, resulting in too-steep keratometric readings. Postoperative hyperopia could only be corrected by an IOL exchange. Because it may not be possible to determine the exact keratometric values for IOL calculation after PRK, subtracting the change in refraction induced by PRK from the preoperative keratometric readings might have been more accurate in this patient.     

A case of interstitial hamartoma in the left lung, suggesting a specific lesion

The author presents a case of the rare lung tumor hamartoma in 63-year-old female patient treated initially as pulmonary tuberculosis. The features of the tumour and diagnostic difficulties are discussed.     

Aspiration of a primary tooth in a patient with a tracheostomy

We report a clinical case of a patient affected by splenic non-Hodgkin lymphoma and virus C hepatitis. It seems that this kind of association is original because as far as we know the association between non-Hodgkin lymphoma and HCV did not include non-Hodgkin lymphoma involving the spleen. Indeed, in our patient, there was an increase of CD/57 lymphocytes. In our opinion this could be interesting in the disorders of the immune system associated with lymphoma.     

Serious, prolonged hypoglycaemia with glibenclamide in a patient with Mendenhall''s syndrome

Mendenhall's syndrome, characterized by familial insulin resistant diabetes, pineal hyperplasia and multiple somatic abnormalities, is associated with defects involving the alpha-subunit of the insulin receptor. The associated insulin-resistant diabetes is extremely difficult to treat; insulin is required in very large doses to control hyperglycaemia and oral hypoglycaemic agents are ineffective. We report a case of severe, prolonged hypoglycaemia that occurred in a 24-year-old patient with Mendenhall's syndrome following therapy with glibenclamide. He had glibenclamide 10 mg daily for 1 week following which he was admitted to hospital in hypoglycaemic coma with blood glucose levels < 1.0 mmol/l. This subject had undergone hypophysectomy at the age of 11 years. Prior to pituitary ablation, oral hypoglycaemic agents did not improve glycaemic control. Thus, previous hypophysectomy in this patient appears to have made it possible for glibenclamide to exert its hypoglycaemic effect. The occurrence of hypoglycaemia in this patient suggests alternative mechanisms for insulin action in conditions characterized by severe insulin resistance due to insulin receptor defects.     

Obstructive Ileus caused by blood clot after emergency total gastrectomy in a patient with hemophilia A: report of a case

We report herein the extremely unusual case of a patient with hemophilia A who developed a hematoma ileus soon after undergoing an emergency total gastrectomy. Postoperatively, the patient was found to have an obstruction in the small intestine that was difficult to differentiate from intussusception. Reoperation revealed the cause of the obstruction to be a large blood clot. This case report serves to demonstrate that careful hemostasis and observation during surgery is essential in patients with hemophilia.     

Coxiella burnetti infectious endocarditis. Apropos of a case

Chronic forms of Q fever (endocarditis) are rare, but are responsible for severe and desperately recurrent infections, resulting in multiple valve replacements with a reserved prognosis. The authors report the case of a 35-year-old patient with a known history of rheumatic fever, who developed blood culture negative infectious endocarditis on a mitral bioprosthesis. The diagnosis of Q fever was based on serological arguments. Despite long-term antibiotic therapy, serology remained strongly positive and was associated with repeated mitral valve disinsertion. The patient died immediately after the fourth operation in a context of haemodynamic failure. This clinical case emphasizes the importance of performing Q fever serology in any case of culture negative endocarditis and the therapeutic difficulties encountered in chronic recurrent endocarditis.     

Incomplete urethral obstruction associated with dilatation of the urethra, cystitis, and pyelonephritis in a Vietnamese pot-bellied pig

A sporadic case of trilateral retinoblastoma in a male child of 20 months is described using clinical and imaging approaches. Attempts were made to find out a tumour marker by analysing human chorionic gonadotrophin (hCG), alpha-feto protein (AFP), carcinoembryonic antigen (CEA), and lactic dehydrogenase (LDH) in blood and cerebrospinal fluid (CSF). Only LDH was elevated in CSF and the rest were normal. Retinoblastoma gene could not be isolated in this patient. It is proposed that LDH in CSF should be analysed in patients with bilateral retinoblastoma who had normal brain scan initially. If LDH level in CSF is elevated, the patient should be periodically monitored by non-invasive imaging of the brain to detect intracranial tumour at an early stage.     

Nebivolol: comparison of the effects of dl-nebivolol, d-nebivolol, l-nebivolol, atenolol, and placebo on exercise-induced increases in heart rate and systolic blood pressure

Congenital subluxation of the peroneal tendons is an uncommon, but not rare condition. In almost all cases, it will spontaneously resolve without requiring any treatment. Presented is a case report of the condition affecting the patient bilaterally. The subluxation did not resolve and the patient was subsequently treated with a modification of the Kelly procedure.     

Kikuchi syndrome, Hashimoto thyroiditis and lupus serology. Apropos of a case

Histiocytic necrotizing lymphadenitis (Kikuchi's disease) is an uncommon disease of the cervical lymph nodes occurring in young women, commonly associated with various auto-immune or infectious diseases. We describe the case of a 17 year-old girl who presented a Kikuchi's lymphadenitis occurring concomitantly with Hashimoto's thyroiditis and lupus serology as anti-nuclear, anti-DNA, anticardiolipid antibodies and hypocomplementemia. The patient was treated with prednisone and hydroxychloroquine. Thirty months after, she is doing well and hydroxychloroquine is continued.