Sensitization versus adaptation in preparation for emergencies: Prior experience with an emergency ration and its acceptability in a stimulated survival situation.

416 soldiers undergoing a 7-day simulated survival experience were issued 8 meat bars as part of the emergency ration. Rating of 5 methods of preparation, number of bars eaten, reports of being "made sick," and attitude toward future use were collected. "The Ss who had previously used the ration, regardless of whether they liked or disliked it, responded more favorably according to all four criteria when compared with those who had no experience with the ration. Even those who had tried the ration and disliked it responded as favorably as those who had not tried it. Fewer of those who had disliked the ration reported having been 'made sick' by the ration than those who had never tried it." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sacral hydatidosis: value of MRI in the diagnosis

We present a case of primary hydatid disease of the sacrum. The diagnosis was made on MR imaging obtained to evaluate the spine for recurrent disc disease. The patient had previously undergone laminectomy elsewhere for L4-5 radiculopathy. Ultrasound-guided aspiration and visualisation of scolices confirmed the diagnosis. No other site of involvement was found.     

Lumbar spinal canal stenosis associated with progressive degenerative changes of the spine. A case report

STUDY DESIGN: Case report. OBJECTIVES: To report a case of spinal canal stenosis associated with progressive degenerative changes of the lumbar spine. SUMMARY OF BACKGROUND DATA: As far as the authors are aware, there has been no similar case reported. METHODS: The clinical features of the case are reported, and the pathology is discussed. RESULTS: In a 40-year-old man, spinal canal stenosis developed, associated with progressive degenerative changes of the lumbar spine. The man underwent posterior decompression and fusion using pedicle screws. The surgical results were satisfactory at the time of writing this report. CONCLUSIONS: This case presented a peculiar clinical course, which could not be categorized under previously reported disorders. It may be a new disease entity of spinal canal stenosis. The surgical outcome was satisfactory 2 years, 6 months after surgery.     

Use of an analysis of variance technique for investigating the differential diagnosis of organic versus functional involvement of symptoms.

Asked 11 clinical psychologists and 1 counseling psychologist to judge 3 behavioral-neurological signs and 3 psychometric signs in various combinations of presence or absence. Results are consistent with previous findings that a linear model adequately accounts for the variability of a judge's responses. The high interjudge agreement correlations and test-retest reliability estimates strongly suggest that psychologists can render reliable and mutually consistent judgments and are discussed in terms of symptom complexity and diversity. 5 of the 6 symptoms made a moderate to sizable contribution toward a diagnosis of organicity, especially the symptom emphasizing the presence of an unusual gait and some trouble grasping objects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dual-phase helical CT of the liver: value of an early-phase acquisition in the differential diagnosis of noncystic focal lesions

OBJECTIVE: Contrast-enhanced helical CT images of the liver are usually obtained during the portal vein phase (PVP), during which the parenchyma achieves peak enhancement. The purpose of this study was to determine whether the addition of arterial-phase (AP) scans would lead to improved characterization of focal lesions. MATERIALS AND METHODS: We reviewed the CT appearance of 102 focal lesions with a proven diagnosis. In the first part of the study, we assessed whether the addition of AP scans influenced the diagnostic performance of the three observers. In the second part of the study, we analyzed the morphologic appearance revealed on CT scans of the different types of lesions in the AP and PVP. RESULTS: The addition of AP scans led to a significant increase in the number of correct diagnoses: 71 lesions (70%) were correctly diagnosed with CT scans in both the AP and the PVP, compared with 54 lesions (53%) correctly diagnosed with CT scans in the PVP alone (p < .01). The largest difference was observed in the diagnosis of focal nodular hyperplasia (FNH) and adenoma (16/24 correct diagnoses instead of 6/24) (p < .005). Conversely, AP images did not significantly contribute to the diagnosis of hemangiomas and metastases. The following morphologic features were seen much more often on AP scans than on PVP scans and had a high positive predictive value (PPV): spoke-wheel pattern (FNH; PPV, 100%), central feeding vessel (FNH; PPV, 100%), and heterogeneous appearance with hyperdense components (hepatocellular carcinoma; PPV, 75%). CONCLUSION: Our data show that the radiologists' evaluation of CT scans in both the AP and the PVP improves the differentiation of hepatocellular carcinoma and FNH from other types of hepatic neoplasms.     

An ELISA assay for the rapid diagnosis of acute bacterial meningitis

The de novo purine synthesis inhibitor 5,10-dideazatetrahydrofolate (DDATHF) has previously been shown to inhibit the growth of mouse L1210 and human CCRF-CEM leukemia cells. The present study demonstrates that both the 6R and 6S diastereomers of DDATHF are also cytotoxic to mammalian cells in a stereospecific manner. The cytotoxic potency of (6R)-DDATHF (also known as Lometrexol) towards different cell lines varied by approximately 14-fold and that of (6S)-DDATHF by as much as 156-fold. Compared to (6R)-DDATHF, (6S)-DDATHF was 6.0- and 7.2-fold more cytotoxic to human WiDr colon adenocarcinoma and Chinese hamster ovary (CHO) cells, respectively, and only 1.5- and 2.0-fold more cytotoxic to human T24 bladder carcinoma and mouse L1210 leukemia cells, respectively. However, compared to (6S)-DDATHF, (6R)-DDATHF was 8.7- and 6.9-fold more cytotoxic to C3H/10T1/2 clone 8 and clone 16 mouse fibroblasts, respectively. Weak inhibition of aminoimidazolecarboximide ribonucleotide formyltransferase (AICARFT, EC 2.1.2.3) appeared to have little role in the cytotoxicity of DDATHF diastereomers to WiDr cells during a 24-h exposure. Although glycinamide ribonucleotide formyltransferase (GARFT, EC 2.1.21) is the main biochemical target of DDATHF, DDATHF stereoisomers' cytotoxic potency showed no clear negative correlation with cellular GARFT levels. However, cellular folylpolyglutamate synthetase (FPGS, EC 6.3.2.17) levels correlated with cytotoxic potency in a positive manner. Surprisingly, two enzyme-dose/DDATHF LD90-response curves were observed for FPGS corresponding to differences in (6R) and (6S)-DDATHF cytotoxic potency among the six cell lines studied.     

A 60-year-old woman with weakness, fatigue, and acute respiratory failure: case report and discussion of the differential diagnosis

A 60-year-old woman with chronic progressive fatigue, diurnal somnolence, proximal muscle weakness, and dyspnea developed acute respiratory failure when given supplemental oxygen. Hypoventilation secondary to neuromuscular dysfunction was suspected by the critical care specialist. Neurologic consultation and supportive laboratory evaluations led to the diagnosis of acid maltase deficiency, which was confirmed by muscle biopsy. The discussion includes a literature review that describes the pathophysiology and treatment of this rare muscle enzyme deficiency disorder. Acid maltase deficiency should be suspected in any adult presenting with hypoxemia, fatigue, and acute respiratory failure.     

Integrated echocardiography (transthoracic-transesophageal) in the differential diagnosis of left atrial myxoma. Description of three clinical cases

Myxomas are the most common of all primary cardiac tumors among adults; most of them originate from the left atrium in the area of the fossa ovalis. Although atrial myxomas are histologically and clinically benign tumors, they can rarely cause severe complications including embolization and sudden death caused by left ventricular outflow tract obstruction and coronary or cerebral embolization. Echocardiography (Transthoracic and transesophageal) has been considered as the procedure of choice for the diagnosis of atrial myxomas. We report 3 cases in which it has been echocardiographically observed at left intra-atrial mass with similar motion behavior and attachment site, where transesophageal echocardiography has been very important to correctly lead the differential diagnosis (between atrial myxoma and atrial thrombus).     

MRI of the spine in cobalamin deficiency: the value of examining both spinal cord and bone marrow

Low back pain is caused by a variety of etiologies. Some clinicians have postulated that much low back pain is due to trauma to the iliolumbar ligament. The iliolumbar ligament is one of the three pelvic-lumbar ligaments and develops during the 12th week of gestation. The iliolumbar ligament appears to be a major stabilizing component between the vertebral spine and the pelvis. The innervation of the iliolumbar ligament appears similar to the posterior lumbar ligaments. Our hypothesis is: micro-trauma to the iliolumbar ligament is the primary cause of many cases of chronic low back pain because (1) it is the weakest component of the multifidus triangle; (2) there is increased susceptibility to injury due to its angulated attachment; (3) it is a primary inhibitor of excess sacral flexion; (4) it is a highly innervated nociceptive tissue; and (5) it plays an increased role with progressive disc degeneration.     

Gas in the spinal canal associated with injury of the cervical spinal cord: a diagnostic dilemma. A case report

This pilot study compared haloperidol, fluoxetine, and placebo for reduction of agitation in 15 outpatients with AD. The two drugs were no more effective than placebo at reducing agitation in these subjects; however, both drugs produced more toxicity than did placebo.     

Use of pulse oximetry in the diagnosis of accidental bronchial intubation during laparoscopic surgery. Description of a clinical case

In the present article a case of accidental bronchial intubation during laparoscopic cholecystectomy is described. Endotracheal tube was probably displaced by gas distension of the abdomen during laparoscopy. Indeed, under these circumstances, carina may move cephalad. Initially, tube displacement was not diagnosed by either auscultation of breath sounds, or ETCO2 monitoring. Instead, a decrease in arterial oxygen saturation, as monitored by pulse oximetry, quickly allowed diagnosis and correction of the problem. It is concluded that pulse oximetry is more sensitive than other methods in providing early warning of tube displacement during laparoscopy.     

Continuous spinal anesthesia vs. combined spinal-epidural anesthesia in emergency surgery. The combined spinal-epidural anesthesia technique does not offer an advantage of spinal anesthesia with a microcatheter

In this prospective study we investigated the efficacy of microcatheter spinal anaesthesia in comparison with a combined spinal-epidural technique in trauma patients. METHODS: After institutional approval 60 patients undergoing urgent lower-limb surgery randomly received either CSA (22 G Sprotte needle, 28 G nylon catheter) in group 1 or CSE (18 G Tuohy needle, 22 G epidural catheter and 25 G pencil-point needle) in group 2. An initial subarachnoid bolus of 2 ml of plain bupivacaine 0.5% was injected in both groups. Difficulties with the lumbar puncture or catheter insertion, the time required for performance of either technique and the onset of analgesia at T12 were documented. If analgesia did not reach T12 within 20 min, supplemental bupivacaine was injected either intrathecally or epidurally up to a maximum of 5 ml in the CSA group or 16 ml in the CSE group. RESULTS: The number of lumbar punctures (CSA: n = 1.8 +/- 1.5; CSE: n = 2.6 +/- 1.8; P = 0.05) and the incidence of technical problems (CSA: 13%, CSE: 47%; P = 0.012) was higher in the CSE group. In contrast to CSA, performance of CSE was more time consuming (CSA: 8 +/- 3 min, CSE: 15 +/- 8 min; P = 0.0003), and the total dose of local anaesthetics was higher in the CSE group (CSA: 3.2 +/- 1 ml, CSE: 9.7 +/- 5 ml; P < 0.0001). CONCLUSIONS: Because of the higher incidence of technical problems, more time was required for the performance of CSE. As a consequence, microcatheter CSA might be preferred over CSE in trauma patients.     

Limited value of fluorine-18-fluorodeoxyglucose PET for the differential diagnosis of focal liver lesions in patients with chronic hepatitis C virus infection

AIM: The differentiation of HCC from liver metastasis or benign disorders by imaging studies based upon morphological aspects may be difficult. METHOD: In order to evaluate the role of tumour metabolism, we performed FDG-PET (whole-body PET and transmission-corrected regional scans of the liver as well as the SUV determined 60 min after injection of FDG) in ten consecutive patients with HCV-associated focal liver lesions. Definite diagnosis was established after ultrasound-guided liver biopsy followed by histopathological examination. These results were compared with ultrasound, computed tomography, serum anti-p53, and p53 protein expression. RESULTS: The histologic examination revealed a HCC in five patients, regenerative nodules in three patients, and liver metastasis (primary malignancy: one adenocarcinoma and one neuroendocrine tumour) in the remaining two patients. Three of ten lesions were detectable by FDG-PET: two HCCs and one metastatic adenocarcinoma. Seven lesions were not distinguishable by FDG-PET (three HCCs, three regeneration nodules and one metastatic neuroendocrine tumour). In each patient hepatic lesions were visible either by ultrasound or CT. Both tumours (metastatic adenocarcinoma, moderately well-differentiated HCC) with the strongest expression of p53 also presented with highly increased FDG uptake. CONCLUSIONS: FDG-PET is not superior to ultrasound or CT and therefore does not allow the non-invasive differentiation of HCV-associated focal liver lesions. Tissue-diagnosis by means of liver-biopsy followed by histopathological examination remains the gold-standard for the differentiation of HCV-related liver lesions. The finding of the relationship of p53 protein overexpression with the SUV needs further confirmation.