Malignant thymoma: a review of 44 cases

Trisomy 12 is a frequent abnormality in chronic lymphocytic leukaemia (CLL). The biological importance of trisomy 12 is still poorly understood but it has been suggested that one or several genes are duplicated leading to malignant transformation. We present a case with amplification of 12q13-22 found in a clinically aggressive relapse of CLL. A smaller region, 12q13-15, was amplified most frequently and a YAC containing the MDM2 gene gave the highest number of signals. Additionally, in a subclone an amplicon containing at least 5 copies of a cosmid from 12q23-24 was detected. The case shows that small duplications of chromosome 12, not revealed by cytogenetic analysis, may occur in CLL. Also, it shows that cytogenetic clonal evolution can occur in CLL without morphological evidence of blast transformation. Our results indicate that the 12q13-15 region carries an important gene for CLL progression.     

The rape victim: a review of 117 consecutive cases

The case records of 117 women examined at University Hospital for the complaint of alleged rape have been reviewed. The usual victim was white, single, under the age of 25 years, and attacked by a single assailant. Fifteen patients sustained serious physical injury, and 60 received minor injuries. Six children required hospitalization for reparative surgery. One patient required hospitalization for 9 days secondary to severe emotional stress. The number of attacks was lowest in the daytime and highest from midnight to 6:00 AM. Cultures from the endocervix were positive for gonorrhea in 12% of rape victims. Unfortunately, it would appear from public records that there is little hope of the attackers being convicted.     

General anesthesia for rhytidectomy: a review of 100 consecutive cases

Although local anesthesia will, and should, continue to be the principal method of anesthesia for most face lift operations, we believe that general endotracheal anesthesia, supplemented by local anesthesia with epinephrine, offers significant advantages in a selected group of patients. We review 100 consecutive rhytidectomies done under this combination of anesthetics. These patients had no significant intraoperative or postoperative problems, and the results compare favorably with the usual technique of local anesthesia plus basal sedation. Good cooperation between surgeon and anesthesiologist, and a thorough understanding of the principles involved in such anesthesia administrations (particularly when relatively large volumes of local anesthesia with epinephrine are going to be used) are necessary for the patient's safe course during the procedure.     

Acanthamoebiasis in Korea: two new cases with clinical cases review

OBJECTIVE: To compare mortality rates on hemodialysis (HD) to rates on continuous ambulatory/cyclic peritoneal dialysis (CAPD/CCPD), to contrast our results with those of other recent investigations, and to discuss reasons for discrepancies. DATA SOURCES: Patient-specific data obtained from the Canadian Organ Replacement Register on patients initiating renal replacement therapy (RRT) between 1 January 1990 and 31 December 1995 (n = 14 483). Recent mortality comparisons of CAPD and HD. MAIN OUTCOME MEASURES: Mortality rate ratio (RR) based on "as-treated" (AT) analysis incorporating treatment modality switches and adjusting for age, primary renal diagnosis, and comorbid conditions using Poisson regression. Hazard ratios (HR) were estimated using Cox regression and based on an "intent-to-treat" (ITT) analysis wherein patients were classified based on dialytic modality received on follow-up day 90. RESULTS: Adjusted mortality rates were significantly decreased on CAPD/CCPD relative to HD [RR = 0.73, 95% confidence interval (CI) = (0.69, 0.77)] based on the AT analysis. Most of the protective effect of CAPD/CCPD was concentrated in the first 2 years of follow-up post-RRT initiation. Based on the ITT analysis, the estimated CAPD/ CCPD effect was greatly reduced, with HR = 0.93 (0.87, 0.99). CONCLUSIONS: We provide further evidence that CAPD/CCPD is not an inferior dialytic modality to HD, particularly in the short term. Comparing mortality rates on CAPD/CCPD and HD is inherently difficult due to the potential for bias. Discrepancies between our results and those of previous investigations, and variability in findings among previous studies, relate to differences in clinical and demographic setting, patient populations, study design, statistical methods, and interaction between the dialytic modality effect and various other covariables.     

Frontoethmoidal meningoencephaloceles: a review of 14 consecutive patients

Over a period of 4.5 years, 14 patients with frontoethmoidal meningoencephaloceles were treated. Most patients came from Northern Namibia. Precise delineation of all cranial abnormalities was obtained by modern imaging techniques, and specific patterns of cerebral abnormality were found. The malformation was corrected in a single stage, and significant modifications have been developed to render the procedure simpler and safer. Information from our series favors delayed neural tube closure as the primary pathogenesis of the defect and suggests a common teratogen as the most probable etiological agent. Our experience leads us to advocate early correction of even small defects.     

Percutaneous dilatational cricothyroidotomy: outcome with 44 consecutive patients

OBJECTIVE: To assess the value of the percutaneous dilatational technique in elective cricothyroidotomy. DESIGN: Forty-four consecutive patients requiring prolonged mechanical ventilation. SETTING: The general 14-bed intensive care unit of a university hospital. INTERVENTIONS: Fourty-four percutaneous dilatational cricothyroidotomies using a multiple-dilator wire-guided procedure. MEASUREMENTS AND RESULTS: The average duration for the procedure was 11 min in 37 patients. No significant complications occurred intraoperatively except for one paratracheal cannula insertion. Postoperative complications were one case of stoma infection, three cases of transient phonatory changes, two cases of a small peristomal granuloma, and one case of persistent stoma. Of 21 decannulated patients, 16 survived to discharge. Long-term follow-up was possible in 14 surviving patients. All were asymptomatic several months after decannulation. CONCLUSIONS: Percutaneous dilatational cricothyroidotomy can be a quick, safe technique, as good as the percutaneous subcricoidal approach in ventilated, critically ill patients.     

Temporal bone fracture: review of 40 cases (44 traumatic injuries)

Temporal bone fractures are common injuries in patients suffering cranio-encephalic traumatisms. They call for a precociuos diagnosis, including a careful oto-neurologic examination as well a computerized tomography (CT), in order to asses sequelae and complications arrised from traumata. Here are reported a review of 40 patients with 44 temporal fractures attended in our Hospital, from January 1993 until March 1996. The injured were clinically evaluated in the ENT-Department by computer radiography and the classic audiovestibular battery tests. Particularly emphasized were luxations of the ossicular chain, lesion of the labyrinthine capsula and peripheral facial palsies. Our basic concern is to evaluate the incidence of petrosal involvement in our environment, owing to the scarcity of the national literature, and to analyze the after maths and the management of postraumatic facial paralyses.     

Aneurysms of the supra-aortic trunks in Takayasu''s disease. Report of two cases

Two new canine osteosarcoma cell lines were established. One (OOS) was established from a 10-year-old female maltese dog with mandibular osteosarcoma and the other (HOS) from a 7-year-old male mongrel dog with scapular osteosarcoma. Histopathological types of OOS and HOS were mixed and fibroblastic cell type, respectively. Transmission electron microscopic features of HOS revealed prominent rough endoplasmic reticulum, suggesting higher malignancy comparing to OOS. Doubling time of OOS and HOS were 45.0 +/- 0.5 hr and 42.0 +/- 0.1 hr, respectively. Alkaline phosphatase activities of OOS and HOS were quite low. Histological features of tumor tissues produced by transplantation of these cells into nude mice were identical to those of original osteosarcomas.     

Pyoderma gangrenosum: a report of 44 cases with follow-up

Results of a study of 44 patients with pyoderma gangrenosum (PG) are presented. Each patient was diagnosed using standardized diagnostic criteria and followed up systematically. Thirty patients were women and 14 men. Their mean age was 50 years (range 11-80). Twenty patients had idiopathic and 14 parainflammatory occurrences (e.g. ulcerative colitis, Crohn's disease), whereas in 10 patients an associated haemoproliferative disease or neoplasia was noted. Whereas idiopathic and parainflammatory PG was found predominantly in women, the association with haemoproliferative diseases occurred more often in men. The lower legs and feet represented the typical predilection sites. Fifty-two per cent of patients had one lesion, 37% had up to five, and 11% had more than five lesions. Histologically, lymphocytic and/or leucocytoclastic vasculitis was present in 73% of the biopsy specimens obtained from the borders of the lesions. Long-term follow-up (n = 42, median follow-up 26.5 months) revealed that eight patients had died, in six cases due to the PG and/or the underlying diseases. Of the remaining 34 patients, 44% are in complete remission without further treatment, whereas continuing therapy is needed in 56%. No difference between idiopathic and parainflammatory PG was demonstrable in the follow-up and in no patient with idiopathic PG was a possibly related disease diagnosed in the follow-up. These data suggest that PG should be considered to be an independent disease and not a purely cutaneous complication in most patients.     

Epidemiologic analysis and clinical course of 84 consecutive cases of pemphigus in eastern Sicily

The effects of intense sound exposure on neural activity in the dorsal cochlear nucleus (DCN) were studied in the rat. Seventeen anesthetized adult rats were exposed to a 10-kHz tone at 125-130 dB SPL for 4 h. Fourteen unexposed rats served as controls. Spontaneous activity (SA) and neural thresholds at the characteristic frequency were measured in three rows of 8-12 sites along the mediolateral, tonotopic, axis of the DCN surface 27-61 days after exposure. The results showed that intense tone exposure induced chronic increases in SA. This hyperactivity was found to be distributed broadly across the DCN with an emphasis around the 10-kHz locus and was associated with shifted response thresholds. These findings demonstrate the usefulness of the rat for studies of physiological phenomena related to noise-induced tinnitus and hearing loss.     

Bertiellosis in man: a review of cases

To study the cognitive effects of diphenylhydantoin (PTH), 17 patients of simple partial or generalised tonic clonic seizure, who were on PTH monotherapy for at least 6 months were included. None of them had a seizure in last one month and their CT scans were normal. Serum PTH levels of these patients were in the therapeutic range (10.2-17.7 micrograms/ml). The clinical signs of PTH toxicity in the form of gingival hyperplasia and cerebellar ataxia were present in 1 patient only. In 3 patients memory quotient (MQ) and Benton visual retention test (BVRT) scores were marginally abnormal but the group difference in the clinical psychometric tests were not significant. P3 latency was also normal in all the patients. In the therapeutic range, PTH does not seem to produce significant cognitive dysfunction.     

Pan-valvular annular calcification in Takayasu's arteritis: report of 3 cases

Takayasu's arteritis is a chronic inflammatory arteriopathy. It mainly affects the aortic arch and its main branches. The aortic valve annulus and coronary and pulmonary arteries are rarely affected. Mitral and tricuspid annular calcification were not reported previously. We identified mitral annular calcification by using transthoracic echocardiography in 3 patients with Takayasu's arteritis, in whom none had any of the reported causes of mitral annular calcification. Two of them had concomitant tricuspid and aortic annular calcification.     

Psychiatric aspects of temporal arteritis: a case report and review of the literature

Temporal arteritis may present with atypical manifestations that can hamper its diagnosis. We report a case presenting with predominantly psychiatric symptoms including psychotic features and affective symptoms both on a background of cognitive impairment. Such clear-cut psychotic symptoms have not been described previously in the literature. Corticosteroid treatment was followed by full remission of psychotic and affective symptoms; treatment with antipsychotic medication was unnecessary. Temporal arteritis should be considered in the differential diagnosis of psychosis and affective disorder in the elderly. The erythrocyte sedimentation rate is a valuable parameter in the assessment of old-age psychiatry patients presenting both with functional and neurologic disorders.     

Acute opiate overdose: characteristics of 190 consecutive cases

AIMS: To characterize the population of drug users consulting the Emergency Room (ER) of a university hospital with acute opiate overdose (AOO) and to assess rate of referral to specialized treatment programme. DESIGN: Survey of a 12-month sample of AOO patients. MEASUREMENTS: Medical and psychosocial features of the drug users, details of emergency treatment and referral by a mobile resuscitation team (SMUR) and the ER of our hospital (CHUV-Lausanne, Switzerland). In addition fatal AOO cases were collected by the Institute of Forensic Medicine (IFM) during the same period. FINDINGS: One hundred and eighty-four cases of AOO (134 patients) were treated. The files of the IFM detailed six additional deceased cases. This population of drug users was characterized by an over-representation of men (73%), by young age (27.4 years), by a high rate of multi-drugs use (90%) and by a high rate of multiple previous overdoses (2.6). Average length of stay was 20.1 hours but 41% of cases stayed less than 8 hours. Only one patient was readmitted within an 8-hour period. When discharged, 78% returned home. Unexpectedly, 67% of patients were not referred to any therapeutic programme for drug addiction. CONCLUSION: This study shows the low mortality of AOO when treated but also demonstrates the need to improve psychosocial evaluation and referral of drug addicts admitted with AOO.     

Computed imaging-assisted stereotactic brain biopsy: a risk analysis of 225 consecutive cases

BACKGROUND: Treatment strategies for intracranial mass lesions are most effective when based upon histopathological diagnoses. Image-guided stereotaxy has provided the means to sample tissue from small or deeply seated intraparenchymal lesions with a relatively high degree of safety and accuracy. Although procedural complications are infrequent, devastating neurological sequelae may result from hemorrhage or direct trauma. This study was undertaken to identify factors that may confer an increased risk of morbidity from stereotactic brain biopsy. METHODS: Two hundred twenty-five consecutive computer-assisted stereotactic brain biopsy procedures were reviewed. Patient age averaged 47.4 years (range, 3-84 years); gender ratio was approximately 2:1 (male:female). Pre-existing medical conditions were identified in nearly half of the cohort. 61.3% of biopsied lesions were lobar; the remainder (38.7%) were "deep-seated" (thalamus, basal ganglia, pineal, hypothalamus, cerebellum, brainstem). Glial tumors accounted for the majority (44.4%) of biopsied lesions; metastases (12.9%) and lymphoma (11.6%) were also relatively common. Demographical, anatomical, surgical, and histological data were compiled and putative risk factors for morbidity identified. These variables were then subjected to univariate and logistic regression analyses to determine their significance as independent predictors of operative risk. RESULTS: Twelve patients suffered complications as a consequence of the biopsy procedure (eight from hemorrhage, four from direct trauma). Major morbidity (hemiparesis, aphasia, obtundation) occurred in eight patients (3.6%). Three patients (1.3%) suffered minor morbidity (transient, mild neurological deficits). One operative fatality occurred (0.4%). An increased risk of morbidity was associated with the preoperative use of antiplatelet agents, chronic corticosteroids, deep-seated lesions, malignant gliomas, and a greater number of biopsy attempts (p < 0.05). Factors not conferring increased morbidity included gender, age, pre-existing illness, extracranial malignancy, cardiac disease, hypertension, diabetes, HIV status, and instrument used to procure the specimen. CONCLUSIONS: Complications arising from stereotactic brain biopsy are infrequent but can be disastrous. Operative risk is a function of several independent variables, including lesion properties (location, histology), preoperative pharmacological therapy (corticosteroids, antiplatelet agents), and operative technique. This analysis suggests that the morbidity of stereotactic brain biopsy may be minimized by risk factor modification.