Acute inversion injury of the ankle: magnetic resonance imaging and clinical outcomes

This study was undertaken to compare the clinical and magnetic resonance imaging results of 24 patients who had sustained ligament injuries after acute inversion injury of the ankle. On magnetic resonance imaging, the following lesions were detected: anterior talofibular ligament tear in 23 patients, calcaneofibular ligament lesion in 15, posterior talofibular ligament lesion in 11, interosseous talocalcaneal ligament lesion in 13, cervical ligament lesion in 12, and deltoid ligament lesion in 8. Compared with the clinical outcome at the follow-up study, there was a statistically significant relationship between interosseous talocalcaneal ligament lesion and each of giving way, pain, and limitation of ankle motion; between cervical ligament lesion and both giving way and pain; and between deltoid ligament lesion and giving way (P < 0.05).     

Periosteal gouty tophi of the anterior mid tibia

Subepithelial hematoma of the renal pelvis (Antopol-Goldman lesion) is an extremely rare lesion. We report on a 55-year-old woman who presented with gross hematuria. It was incorrectly diagnosed as renal pelvic cancer and left radical nephroureterectomy with bladder cuff resection was performed. With awareness and high suspicion of Antopol-Goldman lesion in the radiographic differential diagnosis of a renal pelvic mass, this lesion can be treated conservatively or with partial nephrectomy.     

Presidential address: American Society for Surgery of the hand

Tape recordings of time-compressed (40 and 60%) monosyllables were administered to 11 patients with diffuse unilateral temporal lobe lesion, 4 hemispherectomy patients, and 16 patients with discrete unilateral temporal lobe lesion. Time compression was accomplished with the Fairbanks electromechanical apparatus, which allowed temporal compression but did not introduce frequency distortion. The results revealed that with 60% time compression, all patients with diffuse unilateral cortical lesion showed breakdown of speech discrimination in the ear contralateral to the lesion. Patients with discrete unilateral cortical lesion generally did not demonstrate breakdown with the 60% time-compressed materials.     

Adenocarcinoma of the iris pigment epithelium

We treated an 81-year-old man with a pigmented lesion of his right iris. The lesion was locally excised. Light microscopic examination, including immunohistochemistry, and electron microscopic examination were performed. The diagnosis was low-grade adenocarcinoma arising from the iris pigment epithelium. Adenomatous proliferations of the iris pigment epithelium are exceedingly rare and have not been shown to metastasize. Local resection is recommended if the lesion exhibits growth.     

Cystic lymphangioma of the colon. Endoscopic and histologic features

Cystic lymphangiomas are rare benign tumors of the gastrointestinal tract. Such a lesion was found in the colon of a man who presented with diarrhea and rectal bleeding. The colonoscopic appearances of a smooth, soft polypoid lesion on a broad base should alert the clinician to suspect such a lesion. Histologically the lesion is characterized by submucosal lymphatic spaces with a smooth muscle component in the wall. Though colonoscopic excision, injection, or rupture of the cyst have been advocated as possible modes of treatment, surgical excision is still considered to be the treatment of choice.     

Giant cell reparative granuloma of the phalanx of the hand with aggressive radiographic features

This report describes a giant cell (reparative) granuloma in the proximal phalanx of the third finger of the right hand in a 52-year-old man. Radiographically it showed aggressive features with bony permeation, breaking of the cortex, and soft tissue extension. These features suggested a malignant lesion. Histology was characteristic of giant cell reparative granuloma. This lesion, along with aneurysmal bone cyst and giant cell tumor in the small bones of hand and foot, occasionally may show aggressive features mimicking a malignant lesion.     

Quantitative behavioral study of the acute and long-term effects of two-stage bilateral 6-OHDA-induced lesions of the nigrostriatal dopaminergic system in monkeys.

Bilateral lesions of the nigrostriatal dopaminergic system (2-stage lesions separated by 5–6 months) were induced in 3 monkeys trained to initiate forelimb-reaching movements toward a visual target. After each lesion, analysis of the task performance over several months of regular testing showed that the latency to initiate the movement was permanently prolonged in monkeys showing 90% or more striatal dopamine depletion, whereas animals with less severe depletion completely recovered the task performance. Several months after a unilateral nigrostriatal damage, a lesion on the other side produced impairments only on the side of the body contralateral to that second lesion and did not reinstate the deficits on the side previously affected by the first lesion. This suggests that the remaining intact nigrostriatal dopaminergic system may not be involved in the long-term behavioral recovery observed in monkeys with a unilateral lesion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unilateral paresis of the fourth cranial nerve as the only symptom of mesencephalic ischemia

INTRODUCTION: Lesions of the fourth cranial nerves are infrequently diagnosed in cases of disorder of the oculomotor nerves. Most authors consider head injury to be the usual cause of this lesion, which is also frequently seen in association with a microvascular lesion in persons with blood flow problems. CLINICAL CASE: We present the case of an isolated lesion of the trochlear nerve as a consequence of midbrain ischaemia. CONCLUSIONS: Vascular disorders of the brain stem are an uncommon cause of paresis of the superior oblique muscle of the eye and exceptional as the only symptom.     

Cellular dynamics in early atherosclerotic lesion progression in white carneau pigeons. Spatial and temporal analysis of monocyte and smooth muscle invasion of the intima

The early stages of atherosclerosis are characterized by macrophage invasion of the intimal space and proliferation of smooth muscle cells (SMCs). In this study, we characterize the timing and location of each of these processes. Dividing cells of the developing lesions were labeled with [3H]thymidine at different times during lesion progression. Comparable stages of lesion development were analyzed, with the only variable being the length of time between labeling and necropsy. In this way, the mechanism by which lesion composition changes could be inferred from changes in the distribution of label over time. When cells were labeled just before necropsy, serial sections showed monocyte influx predominantly occurring at lesion edges and resulting in a labeling index of 27%. Near the lesion edge, medial SMCs were not stimulated to proliferate. In contrast, in more central areas of the lesion, monocyte influx and intimal SMC proliferation were minimal. Medial SMC proliferation in central regions, however, was high, with a labeling index of 20% in the upper media. Over time, proliferating medial SMCs migrated into the intimal lesion but did not migrate laterally to any great extent. This migration pattern maintained precise subdomains during lesion development, with each domain representing a different stage of lesion development. The edge of lesions thus represents very early events, central regions indicate later events, and intermediate regions provide information about stages between these extremes.     

Primary basal cell carcinoma of the limbal conjunctiva

BACKGROUND: The authors describe a 66-year-old man with primary basal cell carcinoma of the conjunctiva. He presented with a fleshy nodular conjunctival lesion of 4 months' duration, located at the nasal limbus of the left eye. No associated cutaneous lesions were present. RESULTS: The lesion was completely excised, and results of histopathologic examination showed a primary basal cell carcinoma of the conjunctiva. CONCLUSION: This report provides clinicopathologic evidence that primary basal cell carcinoma can rarely occur in the conjunctiva. The authors summarize two well-documented previously reported cases of this unusual lesion.     

Langerhans cell histiocytosis of the clavicle: a case report

A case of Langerhans cell histiocytosis in a 47-year-old male presenting as an aggressive appearing lesion of the clavicle is reported. It illustrates the difficulties of the radiological diagnosis of a solitary bone lesion.     

Verruciform xanthoma of the penis

Verruciform xanthoma is a rare benign lesion. The most common presentation is at the oral mucosa level, although it has also been described at other locations. Our case is the twelfth verruciform xanthoma of the penis ever published. We highlight the relevance of the differential diagnosis and its excellent prognosis, the choice treatment being the simple exeresis of the lesion.     

Doubly dissociable effects of median- and dorsal-raphé lesions on the performance of the five-choice serial reaction time test of attention in rats

Six experiments examined the effects of selective median (MRN)- and dorsal (DRN)-raphé nucleus lesions on the performance of the five-choice serial reaction time task. In this test rats are required to localize brief visual stimuli presented randomly in one of five locations in approximately 30 min sessions of 100 trials. Both accuracy and latency to respond are measured, as well as the incidence of premature and perseverative responding. Selective 5-HT lesions were induced by intra-raphé infusions of 5,7-dihydroxytryptamine following pretreatment with both a noradrenergic and a dopaminergic re-uptake inhibitor. Analysis of tissue monoamine content demonstrated that the MRN lesion profoundly depleted hippocampal 5-HT (by about 90%) without affecting noradrenaline and dopamine, whereas the DRN lesion primarily depleted (by about 80%) nucleus accumbens and caudate-putamen 5-HT. Rats with 5-HT lesions of the MRN performed the task with a similar degree of accuracy to that exhibited by sham-operated controls. Although the MRN lesion did not affect the latency to respond correctly to the visual targets the lesioned animals collected the food reward significantly faster than the controls. A transient increase in the number of premature responses also resulted from this lesion. In contrast the DRN lesion produced a transient but significant increase in the accuracy of performance, and increased both the speed and the probability of responding. The similarity of the effects following global forebrain 5-HT depletion and the selective DRN lesion suggests that the 5-HT projections of the DRN rather than the MRN may play an important role in impulsive behaviour following 5-HT depletion.     

Analysis of intensity of post-stroke depression and its relationship with the cerebral lesion location

BACKGROUND: Several studies have suggested a close relationship between intensity of poststroke depression and lesion location, but the relationships are not clear for some authors. In this study we try to test the hypothesis that the intensity of depression in an early stage (4th week) of cerebral vascular accidents (CVA) in related to lesion location and type of lesion. PATIENTS AND METHODS: In a sample of one hundred and thirty patients in the fourth week of the evolution of an unilateral CVA, 48 patients fulfilled research diagnostic criteria (RDC) of post-stroke depression (34 major depression; 14 minor depression). Schedule for Affective Disorders and Schizophrenia (SADS) and standard measures of intensity of depression (Hamilton's HRDS, Montgomery-Asberg's MADRS and Beck's BDI) were used. RESULTS: In the fourth week of the evolution of CVA's, depression intensity measures (HRDS and BDI) were significantly higher in anterior lesion when compared to posterior lesions. No significant differences were found between right and left lesions, but both were higher than in non-hemispheric lesions. No significant differences of prevalence or intensity of depression were found in relation to lesion type (hemorrhagic/ischaemic). CONCLUSION: The results confirm a relationship between intensity mood disorders after a cerebral vascular accident and the topography of the lesion.     

Value of arthrography after supination trauma of the ankle

OBJECTIVE: To investigate the merits of arthrography after supination trauma of the ankle. DESIGN AND PATIENTS: In a group of 160 consecutive patients operative exploration was performed in cases where arthrography and/or a delayed physical examination showed positive findings. In all patients arthrography was performed within 48 h after trauma. To determine interobserver agreement, all arthrograms were independently evaluated by two radiologists, both ignorant of the first assessment. RESULTS: The prevalence of an ankle ligament lesion was found to be 76%. Of the 122 patients with a rupture of one or more ankle ligaments, 52% had an isolated anterior talofibular ligament lesion, 3% had an isolated calcaneofibular ligament lesion, and 45% had combined lesions. The site of the lesion was predominantly intraligamentous. In the determination of the presence or absence of an ankle ligament lesion, the specificity and sensitivity of the ankle arthrogram were 71% and 96% respectively. Interobserver agreement on the arthrogram was very good (kappa 0.9). In 1% of patients a clear diagnosis was not possible by means of arthrography. CONCLUSION: Arthrography provides information of high diagnostic quality with excellent interobserver agreement and therefore remains the gold standard for early diagnosis (within 48 h) of a lateral ankle ligament rupture.     

Maternal behavior in rats: Evidence for the involvement of preoptic projections to the ventral tegmental area.

In Exp I, with 21 female Charles River CD rats, bilateral electrolytic lesions of the ventral tegmental area (VTA) severely disrupted maternal behavior. In Exp II, with 56 Ss, lactating Ss that received a unilateral knife cut severing the lateral connections of the medial preoptic area (MPOA) paired with a contralateral lesion of the VTA showed more severe maternal behavior deficits than Ss that received (a) a cut severing the lateral connections of the MPOA paired with an ipsilateral VTA lesion; (b) a cut severing the lateral connections of the MPOA paired with a contralateral lesion of the medial hypothalamus posterior to the MPOA; or (c) a cut severing the lateral connections of the lateral preoptic area paired with a contralateral VTA lesion. The oral components of maternal behavior (retrieving and nest building) were particularly affected as a result of bilateral damage to the system extending from the preoptic area to the VTA. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Angiofibroma of tendon sheath (tenosynovial fibroma) of the foot

The author describes a rare lesion along the lateral aspect of the foot that was diagnosed as angiofibroma. The lesion is benign, and affects males twice as often as females. Its clinical and histologic appearances are illustrated.     

Solitary necrotic nodule of the liver: diagnosis and treatment

In 1983, Shepherd and Lee described the solitary necrotic nodule of the liver, an uncommon non-malignant lesion with a characteristic histological appearance. This nodule can often be misinterpreted as a necrotic secondary tumour. Limited liver resection can make differential diagnosis and cure the lesion.     

Entrapment of the popliteal artery

Popliteal artery entrapment is a rare but recognized cause of vascular insufficiency of the lower extremity. The authors describe the condition in a 26-year-old man. Diagnosis depends on arteriographic demonstration of the lesion. Treatment is surgical and should consist of either a bypass procedure or excision with graft interposition. Acute onset of peripheral vascular symptoms in a young person should arouse suspicion of such a lesion.     

Pathways of migration of transplanted Schwann cells in the demyelinated mouse spinal cord

We have studied the behavior of Schwann cells transplanted at a distance from an induced myelin lesion of the adult mouse spinal cord. These transplanted cells were mouse Schwann cells arising from an immortalized cell line (MSC80) which expresses several Schwann cell phenotypes including the ability to produce myelin. The behavior of MSC80 cells was compared to that of purified rat Schwann cells transplanted in the same conditions. Schwann cells were labeled in vitro with the nuclear fluorochrome Hoechst 33342 and were transplanted at distances of 2-8 mm from a lysolecithin-induced myelin lesion in the spinal cord of shiverer and normal mice. Our results show that transplanted MSC80 cells migrated toward the lesion, in both shiverer and normal mouse spinal cord, preferentially along the ependyma, meninges, and blood vessels. They also migrated along white matter tracts but traveled a longer distance in shiverer (8 mm) than in normal (2-3 mm) white matter. Using these different pathways, MSC80 cells arrived within the lesion of shiverer and normal mouse spinal cord at the average speed of 166 microns/hr (8 mm/48 hr). Migration was most efficient along the ependyma and the meninges where it attained up to 250 microns/hr. Migration was much slower in white matter tracts (95 microns/hr +/- 54 in the shiverer and only 38 microns/hr +/- 3 in the normal mouse). We also provide evidence for the specific attraction of MSC80 cells by the lysolecithin-induced lesion since 1) their number increased progressively with time in the lesion, and 2) MSC80 cells left their preferential pathways of migration specifically at the level of the lesion. Finally, combining the Hoechst Schwann cell labeling method with the immunohistochemical detection of the peripheral myelin protein, P0, we show that some of the MSC80 cells which have reached the lesion participate in myelin repair in both shiverer and normal lesioned mouse spinal cord. A series of control experiments performed with rat Schwann cells indicate that the migrating behavior of transplanted MSC80 cells was identical to that of purified but non-immortalized rat Schwann cells.