Gorham's disease: a literature review and case reports

Gorham's disease (disappearing bone disease, massive osteolysis, idiopathic osteolysis, essential osteolysis, progressive atrophy of bone, spontaneous absorption of bone, phantom bone, hemangiomatosis/lymphangiomatosis of bone, progressive osteolysis) is an extremely rare occurrence. There are fewer than 150 reported cases in the literature. This disorder can be characterized by spontaneous or posttraumatic progressive resorption of bone. The etiology is still very speculative, the prognosis unpredictable, and any effective therapy still unknown. This paper presents a review of the literature and two case reports of suspected Gorham's disease of the bones of the foot.     

Vibrio vulnificus infections: case reports and literature review

This study's purpose was to determine the validity of near-infrared interactance (NIR) and bioelectric impedance (BIA) in tracking changes in body composition over 12 wk of either a high intensity endurance (ET) or resistance (RT) training program in nondieting weight-stable untrained males. Prior to and following the control or training period, each subject completed a series of body composition analyses including hydrostatic weighing (HW) with a measurement of residual volume: anthropometric measurements including height, weight, skinfold, and girth: BIA measurement: and NIR measurements. Based on the HW results, there were no significant body composition changes in the control group. For the ET group, a significant decline in relative body fat resulted from a reduction in fat weight (FW) with no change in fat-free weight (FFW). In the RT group, both a significant decline in FW and an increase in FFW contributed to this group's decline in relative body fat. Tracking changes in relative body fat, FW, and FFW, skinfolds agree reasonably well with HW in all groups while BIA and NIR did not always track body composition changes well. For example, SF and BIA were significantly correlated with the changes in FFW (HW = +4.1%, SF = +4.5%. BIA = +3.1%. NIR = -0.7%) observed in the RT group compared to HW (SF: r-value = 0.45, SEE = 2.5; BIA: r = 0.33, SEE = 3.4) while the NIR measurements were nonsignificant (r = 0.09, SEE = 5.0). Interestingly, NIR underestimated the gain in FFW in the resistance trained group while BIA underestimated the changes in relative body fat. FW, and FFW in the endurance trained group. Based on these results, BIA and NIR appear not to be appropriate measurement tools for tracking body composition changes in endurance and resistance training individuals respectively.     

Disseminated acanthamoeba infection in patients with AIDS: case reports and review

Acanthamoeba infection has been described as an opportunistic infection in persons with AIDS. We report two cases of patients with AIDS and acanthamoeba infection and review the manifestations of this protozoan infection in patients infected with human immunodeficiency virus. The diagnosis of this infection requires a high index of suspicion because the clinical and histologic manifestations may be confused with those of disseminated fungal or algal disease. Clinicians and laboratory personnel should be aware of this potentially fatal condition so that appropriate diagnostic studies can be performed and treatment can be urgently administered. Early initiation of therapy may alter the clinical outcome of the disease.     

Adnexal torsion: endoscopic management, case reports, and review

Nucleotide-binding proteins are often used as molecular switches to control the assembly or activity of macromolecular machines. Recent work has revealed that such molecular switches also regulate the spread of some mobile DNA elements. Bacteriophage Mu and the bacterial transposon Tn7 each use an ATP-dependent molecular switch to select a new site for insertion and to coordinate the assembly of the transposition machinery at that site. Strong parallels between these ATP-dependent transposition proteins and other well-characterized molecular switches, such as Ras and EF-Tu, have emerged.     

Large benign pineal cysts: two case reports with review

Skin biopsies at the plaque regions and adjacent skin obtained from HIV-infected 22-40-year-old patients with Kaposi's sarcoma have been analyzed. Morphological changes revealed depended on the stage of the disease and cell specificity. The alterations were as follows: cell adenoma with degeneration and destruction of cell organelles, changes of the specific granules and microfilaments. Langerhans cells appeared to be most susceptible to HIV and showed all types of changes. In the course of the disease gradual decrease of the activity of the main metabolic enzyme - adenylate cyclase - was recorded.     

Mesenteric ischemia secondary to cocaine abuse: case reports and literature review

In summary, we report two cases of mesenteric ischemia following cocaine abuse in young women. In such cases it is always difficult to prove a direct causal relationship between the abuse of cocaine and mesenteric ischemia. Both our patients were relatively young (in their thirties) and did not have any history of atherosclerosis, and their urine toxicity screens were positive for the use of cocaine. Cocaine-related hospital visits are on the increase. Mesenteric ischemia should be considered in the differential diagnosis when evaluating a young patient with a history of cocaine abuse presenting with an acute abdomen.     

Adult-onset subacute sclerosing panencephalitis: case reports and review of the literature

Temperature was measured during drilling in bovine cortical bone specimens. A surgical drill fitted with a custom-designed speedometer and mounted on a drill press was used to drill holes at one speed, 49,000 rpm, and at forces in the range of 1.5 to 9.0 N. The resulting temperatures were recorded by thermocouples placed at various locations. The distribution of maximum local temperature rise (delta T) was best fitted by the function delta T = aR-b, where R is the distance from the center of the drilled hole and a and b are constants that were found by regression analysis. It was also found that the temperature increased with force, up to about 4.0 N, and then decreased at forces greater than that because of decreased drilling time. A separate series of tests revealed that temperatures were higher in the longitudinal direction than in the circumferential direction; this difference was attributed to the anisotropic thermal properties of bone.     

Triptorelin acetate administration in early pregnancy: case reports and review of the literature

OBJECTIVE: The report estimates the treatment costs, cost-offset effects, and cost-effectiveness of Collaborative Care of depressive illness in primary care. STUDY DESIGN: Treatment costs, cost-offset effects, and cost-effectiveness were assessed in two randomized, controlled trials. In the first randomized trail (N = 217), consulting psychiatrists provide enhanced management of pharmacotherapy and brief psychoeducational interventions to enhance adherence. In the second randomized trial (N = 153). Collaborative Care was implemented through brief cognitive-behavioral therapy and enhanced patient education. Consulting psychologist provided brief psychotherapy supplemented by educational materials and enhanced pharmacotherapy management. RESULTS: Collaborative Care increased the costs of treating depression largely because of the extra visits required to provide the interventions. There was a modest cost offset due to reduced use of specialty mental health services among Collaborative Care patients, but costs of ambulatory medical care services did not differ significantly between the intervention and control groups. Among patients with major depression there was a modest increase in cost-effectiveness. The cost per patient successfully treated was lower for Collaborative Care than for Usual Care patients. For patients with minor depression. Collaborative Care was more costly and not more cost-effective than Usual Care. CONCLUSIONS: Collaborative Care increased depression treatment costs and improved the cost-effectiveness of treatment for patients with major depression. A cost offset in specialty mental health costs, but not medical care costs, was observed. Collaborative Care may provide a means of increasing the value of treatment services for major depression.     

Interhemispheric subdural hematoma in adults: case reports and a review of the literature

The interhemispheric subdural hematoma is a relatively uncommon type of subdural hematoma, especially seen in patients with blood clotting disturbances. When its mass becomes sufficiently large, specific neurological abnormalities such as hemiparesis and signs of the falx syndrome are seen. Treatment can consist of conservative observation or craniotomy and is dictated by the clinical course. Conservative management is the treatment of choice for patients without disturbances of consciousness and for patients with stable clinical conditions. Surgical treatment is necessary in patients with progressive deterioration. Three case reports are presented, as well as a review of 64 cases described in the literature. The salient aspects of this clinical entity are discussed.     

Droperidol in the interim management of severe mania: case reports and literature review

There is little information in the literature concerning the use of droperidol in psychiatry. This article presents three cases in which extremely agitated and treatment-refractory persons with mixed mania derived benefit from droperidol administered orally. Symptomatic improvement, including decreased agitation and intrusiveness, improved sleep, and decreased rates of sleep, was observed with the use of oral droperidol at doses ranging from 10-80 mg daily. The only adverse reaction was a dystonia in one patient. This article also reviews the limited available literature on the use of droperidol in psychiatry. Only eight English language articles describing the use of droperidol for psychosis or agitation were found. Future controlled studies to examine the usefulness of oral dosing of droperidol in mania are suggested.     

Intraduodenal hematoma complicating intestinal biopsy: case reports and review of the literature

We report two cases of postbiopsy duodenal hematoma and review 14 additional cases. Duodenal hematoma predominantly occurs in children and presents with abdominal pain, vomiting, and pancreatitis. Upper gastrointestinal series, abdominal ultrasound, and CT scan are useful in visualizing the hematoma. No comparative studies of the usefulness of these techniques are available, but a CT is indicated if perforation is suspected. The treatment is conservative if no perforation is detected, and resolution of symptoms generally occurs within 2 wk.     

Reflex sympathetic dystrophy in hemiplegia--two case reports and review of the literature

Reflex sympathetic dystrophy (RSD) can be precipitated by a variety of events. We report two cases of RSD in hemiplegic patients detected within three months of the cerebrovascular accidents. Diagnosis of RSD was based upon clinical and scintigraphic findings. Management included elevation, range of movement of the affected joints and analgesics. With treatment, the pain and swelling subsided, range of motion of joints improved and the patients were able to participate in the rehabilitation programme. A high index of suspicion, early diagnosis and aggressive treatment were found to be essential for the successful treatment of RSD.     

Calcification of the fetal heart--four case reports and a literature review

Calcification of the heart and vessels in fetuses is a rare condition. It may be dystrophic or metastatic. An extremely rare form of vascular calcification has been termed 'idiopathic arterial calcification of infancy', which is inherited in an autosomal recessive pattern. We report four cases of myocardial calcifications of different origin diagnosed in utero. The correct diagnosis is very important in regard to genetic counselling.     

Focal segmental glomerulosclerosis in children with acute lymphocytic leukemia: case reports and review of literature

In a randomised double-blind parallel study the gastroduodenal tolerability of 300 mg acetylsalicilic acid daily (ASA, CAS 50-78-2) has been evaluated in the presence of placebo (n = 8), 40 mg pantoprazole (CAS 102625-70-7) daily (8 a.m.) (n = 16) and 300 mg ranitidine (CAS 66357-35-5) daily (8 a.m.) (n = 16) in healthy volunteers using upper GI-endoscopy. The treatment period lasted 14 days, endoscopic controls were performed at entry and repeated at day 14. At entry, the mean endoscopic score averaged 1.0 +/- 0.0 (+/- SEM) in the ASA/placebo, in the ASA/pantoprazole and the ASA/ranitidine group. In the placebo experiments 300 mg ASA daily induced marked gastroduodenal lesions at day 14 (lesion score of 6.8 +/- 1.4 (+/- SEM). Concomitant administration of 40 mg pantoprazole daily offered significant protection against 300 mg ASS daily on day 14 (2.1 +/- 0.6) (+/- SEM) (p < 0.05) vs ASA/placebo. 300 mg ASA plus 300 mg ranitidine daily reduced the damaging score to 4.9 +/- 1.2 (+/- SEM) (n.s. vs ASA/ placebo). Our data suggest that coadministration of 40 mg pantoprazole daily reduces significantly gastroduodenal lesions evoked by 300 mg ASA daily.