Depressive stupor--malignant neuroleptic syndrome--serotonin syndrome. A case contribution to a difficult differential diagnosis]

PURPOSE: Our goal was to assess, with a prospective study, the role of hysterosalpingo-contrast sonography (HyCoSy) with an echocontrast agent and transvaginal ultrasonography alone in the evaluation of tubal status. METHODS: Thirty patients were included in the study. These patients underwent an initial plain transvaginal ultrasound examination the day before the HyCoSy. The findings obtained from both examinations were compared with laparoscopic diagnosis, performed in the same menstrual cycle. RESULTS: The kappa values were 0.48 for patency evaluation and 0.67 for the diagnosis of the presence of at least one patent tube, suggesting a good agreement in both cases between HyCoSy and surgery. HyCoSy had a significantly lower sensitivity (50%), but not a significantly higher specificity (75%), than transvaginal ultrasonography alone in the diagnosis of tubal infertility-related abnormalities such as peritubal adhesions. CONCLUSIONS: The study demonstrates that the HyCoSy is a useful test when scheduling the most suitable treatment for infertile couples.     

Chondroma of the petrous bone. A contribution to differential skull base tumor diagnosis

INTRODUCTION: Cartilaginous tumors of the mid-face and the skull base are rare. CASE REPORT: For the first time, a case report of a chondroma of the base of the ear in a 56-year-old woman is presented. In 1974 the patient developed a facial nerve paralysis while she was pregnant. Twenty-two years later the patient developed persistent headache and CT studies of the head were obtained, which showed an extensive tumorous lesion located at the base of the ear. A tumor was resected through an otoneurosurgical approach. The histological examination showed a chondroma. CONCLUSIONS: Even the rare diagnosis of a chondroma should be considered for a differential diagnosis of skull base tumors.     

Brain abscess. A difficult diagnosis?

It is vital to diagnose brain abscess early, but this can be intricate. Four cases of brain abscess are described, illustrating the diagnostic difficulties. One of the patients had multiple brain abscesses. Important aspects of brain abscess are discussed. Brain abscess should be suspected in cases of increasing intracranial pressure combined with focal neurological signs or epileptic seizures, even with no apparent signs of infection. The characteristic contrast-enhancing ring lesion and surrounding oedema may be sufficient for diagnosis, but biopsy and bacteriological culture are often necessary. Epileptic seizures and various neurological sequelae are common, even if the abscess is treated immediately. Delay in diagnosis may lead to fatal outcome.     

Hereditary angioedema. Complex symptoms can make diagnosis difficult

Although rare, hereditary angioedema is a potentially life-threatening disorder that can be difficult to diagnose. It is characterized by a deficiency in C1 esterase inhibitor (C1 INH). Manifestations include gastrointestinal, subcutaneous, and respiratory edema. Factors that trigger episodes vary. Symptoms typically last 48 to 72 hours, but they can last 4 hours to 1 week. Treatment includes prophylactic therapy with attenuated androgens or antifibrinolytic agents. Acute episodes can be medical emergencies, and airway management is a major concern. The treatment of choice in an acute episode is administration of plasma concentrate of C1 INH.     

Pancreatic cystic lesions of difficult diagnosis

Cystic lesions of the pancreas include pseudocysts (90%), cystic tumors and true cysts. Preoperative diagnosis will guide the therapeutic strategy. Certain malignant or potentially malignant cysts (mucinous cystadenomas and cystadenocarcinomas) should be removed surgically while others (pseudocysts and serous cystadenomas) are almost always benign. In 3 out of 4 cases, the clinical setting guides diagnosis and with adequate imaging (sonography, computed tomography, endosonography) the correct diagnosis can be obtained. Inversely, the nature of a unique macrocyst it is often difficult to identify. Puncture is useful to determine tumor markers which are sometimes helpful in complementing information provided by imaging techniques.     

Dysphagia. Diagnosis, differential diagnosis

The wide scope of differential diagnosis in dysphagia makes interdisplinary team-work essential. The aim of this review therefore is to show the various specialties of medicine dealing with dysphagia and to point out possible causes and therapeutic measures.     

Low-grade myxoid chondrosarcoma of the temporal bone: differential diagnosis and report of two cases

Skull base chondrosarcoma and chordoma are rare tumors that generally have a poor prognosis. In 1973, Heffelfinger et al described a chondroid variant of chordoma, called chondroid chordoma that was found to have a significantly better prognosis than classic chordoma. However, recent evidence suggests that many of the tumors diagnosed as chondroid chordoma may, in fact, be low-grade myxoid chondrosarcomas. This report presents the diagnosis and treatment of two cases of skull base tumor that were diagnosed preoperatively as schwannoma because they were thought initially to be centred on the jugular foramen. Initial histologic evaluation suggested chondroid chordoma, but immunohistologic techniques and a review of the literature led to a diagnosis of low-grade myxoid chondrosarcoma.     

Transvaginal ultrasonography in the diagnosis of pelvic adhesions

We studied the role of transvaginal ultrasonography and clinical factors in the diagnosis of pelvic adhesions in a population of 139 consecutive pre-menopausal non-pregnant women submitted to diagnostic and/or operative laparoscopy between February 1995 and November 1996. All patients underwent transvaginal ultrasonography and were interviewed within 2 days of their laparoscopy. The ultrasonographic impressions were then compared with the laparoscopic diagnosis. Patients were classified as having tuboperitoneal abnormalities if evidence of fimbrial, peritubal and/or peri-ovarian adhesions was encountered during surgery. The overall agreement between the ultrasound test result and the surgical findings was calculated using the kappa index. The adhesion of the ovary to the uterus, as evaluated by transvaginal ultrasonography, is most accurate in diagnosing pelvic adhesions (kappa = 0.5) in comparison with the other ultrasonographic findings and clinical parameters. According to the logistic regression equation that was obtained, the probability of the presence of pelvic adhesions varied between a minimum of 12% for patients with no risk factors to a maximum of 93% for patients with three risk factors (previous pelvic surgery and transvaginal ultrasound findings of blurring of the margins of the ovary and adhesion of the ovary to the uterus).     

Perforated diverticulum of the cecum: a difficult preoperative diagnosis

A patient was admitted for a suspected appendicitis; occasionally, a roentgenogram of abdomen, an echography and a tomography: confirmed the suspect. At laparotomy a perforated diverticulum of cecum is suddenly reported: a segmentary resection of ascending colon is performed. Authors remark, according to literature, that preoperative diagnosis of perforated cecal diverticulum is difficult even today, in spite of diagnostic procedures.     

The radiographic diagnosis of pelvic lipomatosis

Cultured human gastric cancer cell line PAMC82 was studied in vitro to further verify anti-tumor effect sof rare-earth elements and explore their mechanism of tumor inhibition. Inhibitory effects of elements lanthanum and cerium on cell growth, reverse effects of them on reduction of malignancy and effects of them on level of expression of oncogene and cancer suppressor gene were observed. Lanthanum chloride, cerium chloride and mixed rare-earth chloride at levels of 0.5 to 1.5 mmol/L could inhibit obviously growth of cancer cells and change cell morphology and microtubule structure of PAMC82, similar to that of normal cells, their colony-forming ability lowered in soft agar, and expression of tumor suppressor gene p53, p16 and p21 increased and that of gene nm23 lowered.     

Hypoglycemia. Symptoms, differential diagnosis, therapy

The article deals with epidemiologic evaluation of long-term chemical effects. The authors stress difficulties in setting the "cause-effect" relationships and define some typical mistakes in such research.     

Bacterial meningoencephalitis. Case report and differential diagnosis

Products of cleavage of beta-carotene and certain apocarotenoids (beta-apo-4', 8', 10', and 12'-carotenols and citranaxanthol) were studied, and the dynamics of their generation in the presence of an enzyme preparation isolated from rabbit intestinal mucosa was determined. The data suggest that metabolism of beta-apocarotenols involves the production of retinal and beta-apo-14'-carotenal mediated by enzymes different from beta-carotene-15,15'-dioxygenase, which converts beta-carotene to retinal. A scheme of metabolic conversion of beta-carotene is discussed.     

Angle-closure glaucoma. Etiology and differential diagnosis]

The primary factors in determining beef quality grades are the amount and distribution of intramuscular fat percentage (IMFAT). Texture analysis was applied to ultrasound B-mode images from ribeye muscle of live beef cattle to predict its IMFAT. We used wavelet transform (WT) for multiresolutional texture analysis and second-order statistics using a gray-level co-occurrence matrix (GLCM) technique. Sets of WT- and GLCM-based texture features were calculated from ultrasonic images from 207 animals and linear regression methods were used for IMFAT prediction. WT-based features included energy ratios, central moments of wavelet-decomposed subimages and wavelet edge density. The regression model using WT features provided a root mean square error (RMSE) of 1.44 for prediction of IMFAT using validation images, while that of GLCM features provided an RMSE of 1.90. The prediction models using the WT features showed potential for objective quality evaluation in the live animals.