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Selected AbstractsTransverse Sinus Thrombosis Presenting With Acute Hydrocephalus: A Case ReportHEADACHE, Issue 2 2008Lampis C. Stavrinou MD We report on a 32-year-old woman who presented with headache of a 10-day duration, due to acute hydrocephalus. This was a result of a tumefactive lesion of the posterior fossa, which was later proven to be a cerebellar venous infarct caused by unilateral transverse sinus thrombosis. Cerebral dural sinus thrombosis should be considered in the differential diagnosis of new onset of headache. [source] The Trophic Effects of Oestrogen on Male Rat Anterior Pituitary LactotrophsJOURNAL OF NEUROENDOCRINOLOGY, Issue 5 2009L. A. Nolan Rapid but often transient changes in mitotic and apoptotic activity are important components of the pituitary response to changes in the hormonal environment. For example, bilateral adrenalectomy and orchidectomy each result in a wave of increased mitosis lasting approximately 1 week, mediated by the same population of trophically active and, to a large extent, endocrinologically inactive cells. By contrast to these tonic inhibitors of pituitary trophic activity, reports of a progressive increase in lactotroph numbers during pregnancy suggest that oestrogen is a potent and persistent pituitary mitogen. By comparing the amplitude and duration of male rat anterior pituitary mitotic responses to oestrogen treatment, to adrenalectomy, and to a combination of the two, the present study aimed to further clarify the characteristics of the oestrogen-induced trophic response, in particular whether lactotrophs are the predominant cell type involved. Adrenalectomy produced a wave of increased mitotic activity, which resolved within 7 days as expected, whereas oestrogen induced a significant increase in mitotic activity, which was sustained for the 14-day duration of the study. The trophic effects of combining adrenalectomy and oestrogen treatment were not additive in that the statistically insignificant upward trend in mitotic index during the first few days compared to oestrogen treatment alone was entirely abolished by oestrogen pre-treatment. The increase in mitotic activity in lactotrophs induced by oestrogen either with or without adrenalectomy did not result in an increase in the relative size of the prolactin-positive compared to prolactin-negative pituitary parenchymal cell numbers by the end of the study. Despite the marked increase in the lactotroph population that is reported during pregnancy, these data indicate that at least the early (i.e. within 2 weeks) mitotic response to pharmacological doses of oestrogen increases mitotic activity in the lactotroph subpopulation by only 5,8% relative to other cellular subpopulations. Unexpectedly, the mitotic response to oestrogen principally occurs in non-prolactin-containing cells and results in the recruitment, amongst other trophically responsive populations, of the entire subpopulation of prolactin-, adrenocorticotrophic hormone- and luteinising hormone-negative cells that respond mitotically to adrenalectomy. Oestrogen therefore has a previously unrecognised non-cell type-specific trophic effect in the pituitary that obscures the relative expansion of the lactotroph population by inducing concurrent increases in numbers of prolactin-negative cells, the nature of which at least in part remains to be determined. [source] Error propagation from prime variables into specific rates and metabolic fluxes for mammalian cells in perfusion cultureBIOTECHNOLOGY PROGRESS, Issue 4 2009Chetan T. Goudar Abstract Error propagation from prime variables into specific rates and metabolic fluxes was quantified for high-concentration CHO cell perfusion cultivation. Prime variable errors were first determined from repeated measurements and ranged from 4.8 to 12.2%. Errors in nutrient uptake and metabolite/product formation rates for 5,15% error in prime variables ranged from 8,22%. The specific growth rate, however, was characterized by higher uncertainty as 15% errors in the bioreactor and harvest cell concentration resulted in 37.8% error. Metabolic fluxes were estimated for 12 experimental conditions, each of 10 day duration, during 120-day perfusion cultivation and were used to determine error propagation from specific rates into metabolic fluxes. Errors of the greater metabolic fluxes (those related to glycolysis, lactate production, TCA cycle and oxidative phosphorylation) were similar in magnitude to those of the related greater specific rates (glucose, lactate, oxygen and CO2 rates) and were insensitive to errors of the lesser specific rates (amino acid catabolism and biosynthesis rates). Errors of the lesser metabolic fluxes (those related to amino acid metabolism), however, were extremely sensitive to errors of the greater specific rates to the extent that they were no longer representative of cellular metabolism and were much less affected by errors in the lesser specific rates. We show that the relationship between specific rate and metabolic flux error could be accurately described by normalized sensitivity coefficients, which were readily calculated once metabolic fluxes were estimated. Their ease of calculation, along with their ability to accurately describe the specific rate-metabolic flux error relationship, makes them a necessary component of metabolic flux analysis. © 2009 American Institute of Chemical Engineers Biotechnol. Prog., 2009 [source] Theophylline does not potentiate the effects of a low dose of dexamethasone in horses with recurrent airway obstructionEQUINE VETERINARY JOURNAL, Issue 6 2006C. CESARINI Summary Reasons for performing study: Theophylline has been shown to have corticosteroid-sparing effects for the treatment of human asthma. A similar effect, if present in horses, would allow diminishing the dose of corticosteroids administered to equine patients with inflammatory airway diseases. Objectives: To evaluate whether theophylline potentiates the effects of a low dose of dexamethasone when treating horses with recurrent airway obstruction (RAO). Hypothesis: Theophylline has steroid-sparing effects in horses with RAO. Methods: Ten mature mixed breed horses in clinical exacerbation of RAO were studied. Using an incomplete crossover design and 3 experimental periods of 7 days duration, horses were distributed randomly in 5 treatment groups; and administered dexamethasone s.i.d., at either 0.05 mg/kg bwt i.v. or per os, or 0.02 mg/kg bwt alone or combined with theophylline at 5 mg/kg bwt per os b.i.d. A fifth group was treated with theophylline alone at the above dosage. Lung function was evaluated prior to drug administration and then 3 and 7 days later. Results: Oral administration of dexamethasone alone or combined with theophylline failed to improve lung function significantly in RAO affected horses. Theophylline alone also failed to improve lung function in all treated horses. Conversely, dexamethasone administration at 0.05 mg/kg bwt i.v. resulted in a significant improvement in lung function starting on Day 3. Conclusions and potential relevance: Oral theophylline for 7 days did not improve the effects of a low dose of dexamethasone for the treatment of horses with RAO. [source] Effects of clonidine on diuretic response in ascitic patients with cirrhosis and activation of sympathetic nervous system,,HEPATOLOGY, Issue 4 2006Anne Lenaerts The effects of the addition of clonidine to diuretics on the mobilization of ascites in the short term (diuretic response and requirement of diuretics) and the long term (readmissions for tense ascites and requirement of diuretics) were examined in patients with cirrhosis and with increased sympathetic nervous system (SNS) activity. We also studied neurohormonal, hemodynamic effects and side effects of clonidine and diuretics. Patients were randomized to receive placebo (group1, n = 32) or clonidine (0.075 mg) twice daily (group 2, n = 32) for 3 months. After 8 days and for 10 days duration, spironolactone (200 mg/day) was added in both groups. After this period, the dosages of diuretics were individually increased until diuretic response. Responding patients were discharged and followed at the outpatient clinic. During the first hospitalization, the time needed for diuretic response was shorter in group 2 than in group 1. The mean requirement for diuretics was significantly higher in group 1 than in group 2, and the diuretic complications (hyperkalemia and renal impairment) were significantly lower in group 2. Clonidine induced a permanent decrease in SNS activity and delayed decrease in renin/aldosterone levels. During the follow-up, the time to the first readmission for tense ascites was shorter in group 1 than in group 2. Readmissions related to tense ascites or diuretic complications were significantly lower in group 2. The mean requirement for diuretics was significantly higher in group 1 than in group 2. In conclusion, the additional administration of clonidine to diuretics induced an earlier diuretic response associated with fewer diuretic requirements and complications. (HEPATOLOGY 2006;44:844,849.) [source] Cyclicity analysis of precipitation regimes in the Yangtze River basin, ChinaINTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 5 2008S. Becker Abstract Daily precipitation data of 148 weather stations located in the Yangtze River basin (P.R. China) are analysed to detect cycles in the annual frequency of occurrence of precipitation events of 1-, 5- and 10 days duration. These events were defined in terms of exceedances of some selected thresholds. The events corresponding to 10, 25 and 30 mm thresholds for 1-, 5- and 10-day precipitation totals, respectively, are analysed in detail. For the identification of cycles, basin-wide averaged standardized time series of frequency of precipitation events are used. It is found that peaks in the smoothed time series occurred around 1974, 1982 and 1991. The Fourier, autoregressive and wavelet analyses reveal distinct cycles of 7,9 and 2,3 year periods, which dominate large parts of the time series. In addition, a shift towards a 4,5 year period in the annual frequency of precipitation events is noticed since the mid- to late-nineties. Major peaks in the annual frequency of occurrence of precipitation events are expected to occur around 2012, 2015 and 2018 according to the spectrum analyses. Copyright © 2007 Royal Meteorological Society [source] A regional frequency analysis of United Kingdom extreme rainfall from 1961 to 2000INTERNATIONAL JOURNAL OF CLIMATOLOGY, Issue 11 2003H. J. Fowler Abstract Multi-day rainfall events are an important cause of recent severe flooding in the UK, and any change in the magnitude of such events may have severe impacts upon urban structures such as dams, urban drainage systems and flood defences and cause failures to occur. Regional pooling of 1-, 2-, 5- and 10-day annual maxima for 1961 to 2000 from 204 sites across the UK is used in a standard regional frequency analysis to produce generalized extreme value growth curves for long return-period rainfall events for each of nine defined climatological regions. Temporal changes in 1-, 2-, 5- and 10-day annual maxima are examined with L-moments using both a 10 year moving window and the fixed decades of 1961,70, 1971,80, 1981,90 and 1991,2000. A bootstrap technique is then used to assess uncertainty in the fitted decadal growth curves and to identify significant trends in both distribution parameters and quantile estimates. There has been a two-part change in extreme rainfall event occurrence across the UK from 1961 to 2000. Little change is observed at 1 and 2 days duration, but significant decadal-level changes are seen in 5- and 10-day events in many regions. In the south of the UK, growth curves have flattened and 5- and 10-day annual maxima have decreased during the 1990s. However, in the north, the 10-day growth curve has steepened and annual maxima have risen during the 1990s. This is particularly evident in Scotland. The 50 year event in Scotland during 1961,90 has become an 8-year, 11-year and 25-year event in the East, South and North Scotland pooling regions respectively during the 1990s. In northern England the average recurrence interval has also halved. This may have severe implications for design and planning practices in flood control. Copyright © 2003 Royal Meteorological Society [source] Rhabdomyosarcoma of the mandible in a 6-year-old boyINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 4 2006L. E. DAVIDSON Summary., Introduction., Rhabdomyosarcoma is an aggressive malignant tumour composed of neoplastic mesenchymal cells that infiltrate surrounding tissue structures, making their precise site of origin unclear. Although rare, this is highly aggressive and the most common soft-tissue neoplasm of the head and neck in children. Regrettably by the time most cases are initially seen, the patients already have large tumours, due to rapid tumour growth and delayed medical consultation. Case Report., This report describes a 6-year-old presenting with just such symptoms of facial swelling and pain but elicitation of further information and findings, including tooth mobility of 3 days duration, led to prompt referral and early treatment of an embryonal rhabdomyosarcoma. Conclusion., General dental practitioners are frequently presented with a child with a swollen face and pain. Experience would suggest a dental abscess to be the most likely cause with treatment as appropriate. However, all swellings in children, should be thoroughly investigated and reviewed as particularly in this age group, tumour growth is rapid while early diagnosis allows successful treatment with multimodality therapy. [source] Introduction of a High-Energy Diet Acutely Up-Regulates Hypothalamic Cocaine and Amphetamine-Regulated Transcript, Mc4R and Brown Adipose Tissue Uncoupling Protein-1 Gene Expression in Male Sprague-Dawley RatsJOURNAL OF NEUROENDOCRINOLOGY, Issue 1 2005Z. A. Archer Abstract Obesity is an escalating problem in Western societies. Susceptibility to weight gain within an obesogenic environment is variable. It remains unclear how the range of weight gain responses are generated. It is possible that an individual's immediate and/or sustained appetite for apparently palatable foods, or metabolic adaptations to a new diet could be important. The present study therefore examined the short- to medium-term effects of a high-energy (HE) diet on bodyweight, food intake, and energy balance-related signalling systems. Sprague-Dawley rats were fed either chow or an HE diet for 12 h, 24 h, 48 h or 14 days. Blood hormones and metabolites were assayed, and expression of uncoupling protein-1 (UCP-1) and hypothalamic energy-balance related genes were determined by Northern blotting or in situ hybridisation, respectively. Short-term exposure (12 h, 24 h, 48 h) to the HE diet had no effect on grams of food consumed, but caloric intake was increased. Exposure to HE diet for 14 days (medium term) established a bodyweight differential of 7.7 g, and animals exhibited a transient increase in caloric intake of 5 days duration. Terminal levels of leptin, insulin, glucose and non-esterified fatty acids (NEFAs) were all increased in HE-fed animals. UCP-1 mRNA was elevated in interscapular brown adipose tissue from HE-fed rats only at 12 h. Cocaine and amphetamine-regulated transcript (CART) and Mc4R gene expression in the hypothalamus were increased after 12 h and 24 h on an HE diet, respectively. The rats appear to passively over-consume calories as a result of consuming a similar weight of a more energy dense food. This evokes physiological responses, which adjust caloric intake over several days. Circulating NEFA and insulin concentrations, UCP-1, Mc4R and CART gene expression are increased as an immediate consequence of consuming HE diet, and may be involved in countering hypercaloric intake. Circulating leptin is increased in the HE-fed animals after 48 h, reflecting their increasing adiposity. [source] Mycoplasma pneumoniae infection in a clinical settingPEDIATRICS INTERNATIONAL, Issue 5 2008Norlijah Othman Abstract Background: Mycoplasma pneumoniae infection predominantly affects the respiratory tract, although the other organs may also be involved. Previous studies compared the clinical features of patients with M. pneumonia pneumonia to other pathogens and these studies were predominantly adult case series rather than involving children. The objectives of the present study were to compare the clinical features, laboratory, and radiographic findings in children seropositive for M. pneumoniae infection with children tested for suspected M. pneumoniae infection who were seronegative. Methods: Using a retrospective review of children who had complement fixation test (CFT) performed for suspected M. pneumoniae infection, children were classified as seropositive if the acute phase serum titer was ,64, or paired samples taken 2,4 weeks apart showed a fourfold or greater rise in serum titer. In contrast, a patient with an antibody titer <64 or with paired sera showing less than a fourfold rise in titer was considered seronegative. Results: One hundred and fifty-one children were included. Seventy-six children had serological evidence of M. pneumoniae infection and the remaining 75 were seronegative. Children with M. pneumoniae infection were more likely to have fever >6 days duration prior to admission, crackles on auscultation, radiographic consolidation and thrombocytosis at presentation. In addition, M. pneumoniae infection was associated with pneumonia whereas seronegative children were more likely to have upper respiratory tract infection or asthma. Conclusions: Certain clinical parameters could assist in gauging the likelihood of M. pneumoniae infection in children, and thus direct whether antibiotic treatment is needed. [source] Applied environmental stresses to enhance the levels of polyphenolics in leaves of hawthorn plantsPHYSIOLOGIA PLANTARUM, Issue 2 2004Ara Kirakosyan In this investigation, two species of Crataegus (hawthorn) were chosen because their polyphenolic constituents have recently received greater attention for the treatment of patients with severe heart disease. One-year-old plants of hawthorn (Crataegus laevigata and C. monogyna) were subjected to water-deficit (continuous water deprivation), cold (4°C), flooding (immersion of roots of plants in water) or herbivory (leaf removal) stress treatments (each of 10 days duration) in order to assess their effects on levels of polyphenolics, namely (-)-epicatechin, catechin, chlorogenic acid, vitexin, vitexin-2,,- O -rhamnoside, acetylvitexin-2,,- O -rhamnoside, hyperoside, quercetin, and rutin in the leaves. The working hypothesis followed is that one or more of these stress treatment will elicit increases in the levels of these polyphenolics. Cold stress causes increases in levels of vitexin-2,,- O -rhamnoside, acetylvitexin-2,,- O -rhamnoside, hyperoside, and quercetin in both Crataegus species. Water-deficit stress increased the productivity of chlorogenic acid, catechin, and (-)-epicatechin in both hawthorn species. Flooding and herbivory caused no net increases, and in some cases, decreases in levels of polyphenolics. These studies indicate that either water-deficit stress or cold stress treatments, or a combination of the two, can be used to enhance the levels of desired polyphenolics in the leaves of these two hawthorn species in a photobioreactor system. These results may have significance for hawthorn in adapting to water-deficit or cold stress and are important considerations for the use of hawthorn in the treatment of heart disease in humans. [source] Effect of different levels of Quebracho tannin on nitrogen utilization and growth performance of Najdi sheep fed alfalfa (Medicago sativa) hay as a sole dietANIMAL SCIENCE JOURNAL, Issue 5 2009Soliman N. AL-DOBAIB ABSTRACT A commercial tannin source (Quebracho tannin, QT), containing 75% condensed tannins (CT) in dry matter (DM) was used to evaluate the effects of addition of different levels of QT to alfalfa hay on the in vitro degradation kinetics of organic matter (OM) and nitrogen (N) in experiment 1 (Exp. 1), N utilization and microbial N synthesis (MNS) in experiment 2 (Exp. 2) and growth performance of growing Najdi lambs in experiment 3 (Exp. 3). Alfalfa hay was treated with QT at the levels of 0, 1, 2 and 3% of DM to form four treatments of QT0, QT1, QT2 and QT3 to have actual levels of CT being 0, 0.75, 1.5 and 2.25% of DM, respectively. Degradation rate and the effective degradability of N were significantly decreased (P < 0.05) for QT2 and QT3 as compared with the QT0. In Exp. 2, digestibility coefficients for OM, neutral detergent fiber and acid detergent fiber were significantly decreased (P < 0.05) at QT3, whereas QT1 and QT2 showed no difference toQT0. In the metabolism trial (Exp. 2), digested N (DN) and urinary N (UN) excretion for QT2 and QT3 were significantly decreased (P < 0.05) compared to QT0 and QT1. The DN and UN as percentage of N intake were 79.2, 76.9, 75.5 and 69.8%; and 24.4, 22.6, 19.9 and 19.6% for QT0, QT1, QT2 and QT3, respectively. QT2 had the highest MNS and the lowest value was in QT3, the MNS of the treatments were 18.1, 18.7, 19.2 and 15.8 g/day for QT0, QT1, QT2 and QT3, respectively. In the growth trial of 56 days duration (Exp. 3, n = 24 lambs), the addition of QT at the level of QT2 enhanced (P < 0.05) the average daily gain and feed conversion rate compared with the QT0, while, QT1 and QT3 had intermediate values. It is concluded that alfalfa hay treated with QT at the level of 2% of DM could be used to protect alfalfa N from ruminal degradation that would lead to improve growth performance of lambs. [source] Effect of periparturient diseases accompanied by excessive vulval discharge and weaning to mating interval on sow reproductive performanceAUSTRALIAN VETERINARY JOURNAL, Issue 9 2002CM WALLER Objective To evaluate the effect of periparturient disease accompanied by vulval discharge, and weaning-to-mating intervals, on sow fertility and litter size. Design Reproductive data were collected and analysed from 19 Hungarian swine herds over a 4 year period. Conception rates, farrowing rates and litter sizes of sows with periparturient disease accompanied by vulval discharge were used to evaluate the relationship between duration of vulval discharge and subsequent fertility and litter size. The possibility of interactions between weaning-to-mating intervals and duration of vulval discharges was investigated to determine if there was any effect on subsequent fertility and litter size. Results and conclusions Both parity 1 and parity 2 to 8 sows having had periparturient disease accompanied by vulval discharge in excess of 6 days duration had significantly (P < 0.001) lower subsequent fertility (conception, farrowing and adjusted farrowing rates) compared with sows of similar parity where the duration of vulval discharge was <4 or 4 to 6 days. There was no difference in fertility rates between sows, in both parity categories, with vulval discharge for <4 days compared with 4 to 6 days. A duration of vulval discharge in excess of 6 days in parity 1 sows significantly reduced litter size (total born and live-born) in subsequent farrowings, but not in parity 2 to 8 sows. There was no interaction between the duration of vulval discharge and post-weaning to mating intervals. However sows with weaning to mating intervals between 7 and 10 days had smaller (P < 0.001) subsequent litter sizes compared with 3 to 6 or 11 to 14 day intervals. It was concluded that the duration of vulval discharge in excess of 6 days was an indication of a severe persistent endometritis adversely affecting fertility of sows. [source] The effect of streptozotocin-induced diabetes on cardiac ,-adrenoceptor subtypes in the ratAUTONOMIC & AUTACOID PHARMACOLOGY, Issue 1 2001D. J. Sellers 1,The present study investigates the effect of short-term experimental diabetes of 14-days duration on the ,-adrenoceptor subtypes of the rat heart. 2,,-adrenoceptor-mediated functional responses to submaximal doses of isoprenaline were enhanced in Langendorff-perfused hearts from diabetic rats, manifested as greater changes in tension, heart rate and rates of tension development (+dT/dt) and decline (,dT/dt). 3,Radioligand binding data demonstrated that total cardiac ,-adrenoceptor density and affinity for [3H]-dihydroalprenolol was unchanged by diabetes, although a decrease in ,1 -adrenoceptor density and increase in ,2 -adrenoceptor density was observed. 4,In conclusion, hearts from 14-day streptozotocin-induced diabetic rats demonstrate a number of alterations within the ,-adrenoceptor system. However, the enhanced ,-adrenoceptor-mediated responses to isoprenaline were not caused by an overall increase in density of ,-adrenoceptors, but were accompanied by changes in the ratio of the ,-adrenoceptor subtypes. [source] Uncommon skin lesion in a patient with ataxia-telangiectasiaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2008Chinedu Ivonye MD A 20-year-old African-American man, with a history of ataxia-telangiectasia diagnosed at the age of one year, presented to the hospital with fever, cough, and headache of 2 days' duration. The fever was of high grade, associated with chills and rigors. The headache was frontal in location, constant, pounding in nature, and associated with photophobia and phonophobia; there was no neck pain, no neck stiffness, and no blurring of vision. The patient complained of facial pain. There were no relieving or aggravating factors. The family denied any change in mental status. ,The cough was productive of yellowish sputum. There was associated rhinorrhea. The patient complained of nausea and vomiting with the headache. A review of other systems was negative. ,On presentation in the emergency room, the patient was tachypneic, febrile, and tachycardic. He was oriented to time, place, and person. His neck was supple and meningeal signs were negative. He had maxillary sinus tenderness. Neurologic examination revealed nystagmus, ocular telangiectasia (Fig. 1), ataxia, and globally decreased muscle strength. Skin examination showed hypopigmented areas on all four extremities, the face, and neck (Figs 1,4), without involvement of the trunk. The rest of the physical examination was unremarkable. Figure 1. Area of vitiligo on the neck with premature graying of the hair Figure 2. Vitiligo on the hands Figure 3. Vitiligo involving the legs Figure 4. Ocular telangiectasia ,The leukocyte count was elevated at 19,600/mcL, with a differential of neutrophils (84%), monocytes (11%), and lymphocytes (5%). Hemoglobin and hematocrit were normal. Chemistry and chest X-ray were normal. ,Computed tomography scan of the head showed acute sinusitis and cerebellar atrophy consistent with ataxia-telangiectasia. ,A lumbar puncture was performed, and cerebrospinal fluid findings were suggestive of aseptic meningitis. ,The patient was treated for aseptic meningitis and acute sinusitis with acyclovir and ceftriaxone. The leukocyte count normalized, the patient remained afebrile, and was asymptomatic after 2 days of treatment with antimicrobials. The rest of the hospital stay was uneventful. [source] Extramedullary granulocytic sarcoma of the skin, mediastinum, and pericardiumINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 3 2008Mohammad Diab MD A 27-year-old man, with a past history of developmental delay, presented on 18 November 2005 for the evaluation of an acute onset of multiple red,violaceous nodules on the head, neck, and trunk of 5 days' duration. The patient had no associated fever, chills, weight loss, night sweats, chest pain, dyspnea, lymphadenopathy, or organomegaly. He had no previous history of malignancies. A biopsy indicated a diagnosis of leukemia cutis (Fig. 1). His initial complete blood count (CBC) was within normal limits. The 2-week follow-up revealed enlargement of the previous lesions and the development of new lesions (Fig. 2). By the third week, the patient had developed dyspnea, but with normal breath sounds and oxygen saturation. Chest computed tomography demonstrated a mediastinal mass measuring 16 × 5.2 cm and pericardial thickening (Fig. 3). The diagnosis of granulocytic sarcoma of the skin lesion and mediastinal mass was established on the basis of immunohistochemical stains, with positivity to CD43 and Leder's preparation and negativity to CD3, CD4, CD5, CD8, CD10, CD20, CD23, CD30, CD34, CD56, bcl-1, terminal deoxynucleotidyl transferase (TdT), and granzyme. The bone marrow was negative for malignant cells. CBC and chemistry panel were all normal. Nevertheless, the patient experienced increased dyspnea and developed a pericardial effusion which required a pericardial window. Cytology of the pericardial fluid was consistent with granulocytic sarcoma. Once the diagnosis of granulocytic sarcoma was established, the patient started a regimen of cytarabine, daunorubicin, and etoposide. Despite this, the skin lesions and mediastinal mass showed minimal response. Repeat computed tomography showed a mediastinal mass measuring 14.5 × 4.4 cm. The patient's respiratory status required intubation and, 2 weeks later, his family requested that he be withdrawn from life support. Figure 1. Immature myelocytic infiltrate in the dermis (hematoxylin and eosin, ×4) Figure 2. Clinical image of granulocytic sarcoma Figure 3. Computed tomography of the chest illustrating mediastinal pericardial involvement [source] An unusual association of pemphigus vulgaris with hyperprolactinemiaINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 10 2002MNAMS, Sujay Khandpur MD A 21-year-old unmarried woman presented with oral ulcerations and generalized, itchy, fluid-filled, skin lesions of 10 days' duration. The lesions ruptured spontaneously, resulting in extensive denuded areas covered by crusts. One month prior to this, she experienced pain and enlargement of both breasts with galactorrhea. Her menstrual cycles were normal initially, but later she developed menstrual irregularities. No past history suggestive of any other systemic or skin disease, including atopy or drug allergies, could be obtained. Her family history was not contributory. Dermatologic examination revealed multiple, flaccid bullae and extensive denuded areas of skin covered with crusts over the scalp, face, trunk, and upper and lower limbs (Fig. 1). Bulla spread sign and Nikolsky's sign were positive. The oral mucosa, including the lips, buccal surface, tongue, and palate, showed multiple erosions covered with necrotic slough. The rest of the mucocutaneous and systemic examination was within normal limits. Figure 1. Extensive erosions and flaccid bullae over the trunk with breast enlargement The patient's diagnostic work-up revealed: hemoglobin, 11.2 g%; total leukocyte count, 7400/mm3; differential leukocyte count, P62L34E2M2; erythrocyte sedimentation rate, 34 mm/h. A peripheral blood smear examination, urinalysis, blood sugar, and renal and liver function tests were normal. Venereal Disease Research Laboratory (VDRL) test and enzyme-linked immunoabsorbent assay (ELISA) for human immunodeficiency virus (HIV) were nonreactive. Antinuclear antibody, lupus erythematosus (LE) cell, rheumatoid factor, and anti-dsDNA levels were normal. Serum protein electrophoresis demonstrated increased levels of immunoglobulin G (IgG) antibody. The serum prolactin level was significantly raised to 139.49 ng/mL (normal, 3.6,18.9 ng/mL). The sex hormone levels, however, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and progesterone, were within normal limits. The thyroid hormone profile was also unaltered. Chest X-ray was normal. Ultrasound of the abdomen and pelvis revealed no visceral abnormality and computerized tomography (CT) scan of the pituitary sella showed no adenoma. Mammography was negative for breast malignancy. A Tzanck smear prepared from the base of the erosion showed multiple acantholytic cells and lymphocytes. Histologic examination from an intact vesicle was suggestive of pemphigus vulgaris (PV), showing a suprabasal cleft with acantholytic cells and the basal layer demonstrating a "row of tombstones" appearance (Fig. 2). Direct immunofluorescence (DIF) revealed the intercellular deposition of IgG and C3 throughout the epidermis in a "fishnet pattern." Indirect immunofluorescence (IIF) test performed on rat esophagus for circulating IgG antibody was positive in a titer of 1 : 120. Figure 2. Photomicrograph showing suprabasal cleft with "row of tombstones" appearance, suggestive of pemphigus vulgaris (hematoxylin and eosin, × 40) Based on the clinical and immunohistological features, a diagnosis of PV with idiopathic hyperprolactinemia was made. The patient was treated with bromocriptine mesylate (Tablet Proctinal, Glaxo Wellcome Ltd, India) at a dose of 2.5 mg twice a day. After 2 months of therapy, significant improvement in the skin lesions was observed. The existing lesions re-epithelialized with a drastic reduction in the number and distribution of new vesicles. However, no change in the mucosal erosions was noticed. IIF test demonstrated a lower antibody titer (1 : 40). The breast complaints also improved with a reduction in serum prolactin level to 6.5 ng/mL. The patient refused further treatment as she experienced nausea and dizziness with bromocriptine. After 2 weeks, the disease relapsed with the appearance of new vesicles over the forearms, abdomen, back, and thighs. She again complained of breast tenderness and galactorrhea, and the serum prolactin level was 95 ng/mL. The IgG titer increased to 1 : 120. Hence, treatment with oral prednisolone (2 mg/kg/day) and bromocriptine (2.5 mg twice a day) with an antiemetic was initiated. After 6 weeks, the skin lesions had cleared completely, the breast symptoms had improved, menses had become regular, and the prolactin level had decreased to 4 ng/mL. IIF test was negative for circulating antibody. Steroids were tapered off and maintenance therapy with bromocriptine at a dose of 2.5 mg/day was continued. [source] Majocchi's granuloma trichophyticum in an immunocompromised patientINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2000Somesh Gupta MD A 40-year-old man with alcoholic liver disease was referred to the dermatology clinic for asymptomatic papulonodular lesions over the face of 15 days' duration. Cutaneous examination revealed multiple, dusky red to yellow, follicular as well as perifollicular papulonodular lesions, varying in size from 0.5 to 2 cm ( Fig. 1). They were distributed over the forehead, cheeks, eyelids, nose, chin, beard area, retroauricular area, and neck. Careful examination revealed well-defined scaly margins on the back of the pinna ( Fig. 2). KOH examination of a scraping from the neck revealed nonpigmented septate hyphae. Histopathologic examination of the excised nodule revealed epitheloid cell granulomas with neutrophilic microabscesses surrounding the hair follicles. Periodic acid,Schiff stain was noncontributory. Culture of an excised nodule on Sabouraud's agar showed growth of Trichophyton rubrum. Considering his liver disease, the patient was initially treated with topical terbinafine. Because of a lack of a satisfactory response this was changed to oral terbinafine 250 mg/day. There was marked regression of the lesions by the sixth day. Unfortunately, the patient succumbed to complications relating to his liver disease. Figure 1. Follicular and perifollicular lesions of Majocchi's granuloma Figure 2. A well-defined scaly margin of tinea on the back of the pina [source] Tracheal perforation secondary to suture irritation in a dog following a ventral slot procedureJOURNAL OF SMALL ANIMAL PRACTICE, Issue 7 2003D. N. Clements An eight-year-old springer spaniel was presented with acute-onset subcutaneous emphysema of five days' duration. The dog had undergone ventral slot decompression of the C5-C6 intervertebral disc space eight weeks before presentation. Cervical tracheoscopy demonstrated perforation of the dorsal tracheal membrane of the distal cervical trachea. Perforation of the dorsal tracheal membrane secondary to suture knot irritation was confirmed by exploratory surgery. Repair of the perforation was performed by plication of the dorsal tracheal membrane. The dog was represented nine days after the initial surgery with acute recurrence of subcutaneous emphysema. Air leakage at the plicated dorsal tracheal membrane was observed at exploratory surgery, and a bipedicle sternothyroideus muscle flap was used to support the plicated membrane. Recovery was uneventful and 10 months postoperatively there had been no recurrence of clinical signs. [source] Alpha-fetoprotein producing uterine corpus carcinoma: A hepatoid adenocarcinoma of the endometriumPATHOLOGY INTERNATIONAL, Issue 10 2000Hiroshi Toyoda A case of alpha-fetoprotein (AFP) producing endometrial carcinoma in a 60-year-old Japanese woman is presented. The patient complained of abnormal vaginal bleeding of 10 days' duration. On admission a uterine corpus mass and high serum AFP concentration (31950 ng/mL) was noted. There was no tumorous lesion in any other organ radiographically and endoscopically. Histologically, the biopsy specimen taken from the uterine mass showed a poorly differentiated endometrial carcinoma and a radical hysterectomy was subsequently performed. The postoperative serum AFP value transiently decreased with chemotherapy, however, lung metastases were found and the patient died 12 months following surgery. The resected uterus had a necrotic tumor, 6 × 5 × 4 cm in size, filling the endometrial cavity, characterized by exophytic growth with infiltration in the myometrium. Histologically, the tumor was composed of the main medullary carcinoma area with microcysts and admixed small areas of well-differentiated endometrioid adenocarcinoma, accompanied by a smooth transition with one another. In both the areas, the tumor cells had immunoreactive AFP, alpha-1-antitripsin, albumin, transferrin, carcinoembryonic antigen, CA19-9, and epithelial membrane antigen. There was no histologic evidence for a germ cell tumor. Based on these findings, this uterine corpus tumor was regarded as hepatoid variant of endometrial carcinoma. Although the histogenesis remains controversial, we assume the hypothesis that the tumor may arise in the endometrium per se in association with abnormal differentiation of muellerian duct elements. [source] Serum zinc levels in children with acute gastroenteritisPEDIATRICS INTERNATIONAL, Issue 3 2007AKGÜN ÖLMEZ Abstract Background: The aim of the present study was to determine the serum zinc levels on admission and 7,10 days after clinical recovery from acute gastroenteritis of <8 days' duration. Methods: This prospective study included 82 infants aged 2,24 months who had no associated bacterial infection, chronic disease, prior antibiotic use, moderate or severe malnutrition or dysentery. Forty-one healthy children formed the control group. Results: The mean serum zinc level on admission (Zn1) was 11.85 ± 2.83 ,mol/L and at 7,10 days after recovery (Zn2) was 10.92 ± 2.17 ,mol/L; mean serum zinc level of the control group was 11.81 ± 3.45 ,mol/L. Zn2 was significantly lower than Zn1, but there was no statistical difference between the mean of the control group and Zn1 and Zn2. When dehydrated patients were excluded from the patient group, Zn1 and Zn2 did not differ. Although asymptomatic, 39% of the control group had low zinc. Serum zinc levels were not affected by sex, age, clinical characteristics of the patients or severity of gastroenteritis. Conclusion: Serum zinc levels of the patients admitted with acute gastroenteritis without any other disease and without moderate or severe malnutrition were not affected by disease state. Gastroenteritis did not further decrease serum zinc levels in patients with asymptomatic or subclinical zinc deficiency. [source] Prospective Validation of the Pediatric Appendicitis Score in a Canadian Pediatric Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 7 2009Maala Bhatt MD Abstract Objectives:, Clinical scoring systems attempt to improve the diagnostic accuracy of pediatric appendicitis. The Pediatric Appendicitis Score (PAS) was the first score created specifically for children and showed excellent performance in the derivation study when administered by pediatric surgeons. The objective was to validate the score in a nonreferred population by emergency physicians (EPs). Methods:, A convenience sample of children, 4,18 years old presenting to a pediatric emergency department (ED) with abdominal pain of less than 3 days' duration and in whom the treating physician suspected appendicitis, was prospectively evaluated. Children who were nonverbal, had a previous appendectomy, or had chronic abdominal pathology were excluded. Score components (right lower quadrant and hop tenderness, anorexia, pyrexia, emesis, pain migration, leukocytosis, and neutrophilia) were collected on standardized forms by EPs who were blinded to the scoring system. Interobserver assessments were completed when possible. Appendicitis was defined as appendectomy with positive histology. Outcomes were ascertained by review of the pathology reports from the surgery specimens for children undergoing surgery and by telephone follow-up for children who were discharged home. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated. The overall performance of the score was assessed by a receiver operator characteristic (ROC) curve. Results:, Of the enrolled children who met inclusion criteria (n = 246), 83 (34%) had pathology-proven appendicitis. Using the single cut-point suggested in the derivation study (PAS 5) resulted in an unacceptably high number of false positives (37.6%). The score's performance improved when two cut-points were used. When children with a PAS of ,4 were discharged home without further investigations, the sensitivity was 97.6% with a NPV of 97.7%. When a PAS of ,8 determined the need for appendectomy, the score's specificity was 95.1% with a PPV of 85.2%. Using this strategy, the negative appendectomy rate would have been 8.8%, the missed appendicitis rate would have been 2.4%, and 41% of imaging investigations would have been avoided. Conclusions:, The PAS is a useful tool in the evaluation of children with possible appendicitis. Scores of ,4 help rule out appendicitis, while scores of ,8 help predict appendicitis. Patients with a PAS of 5,7 may need further radiologic evaluation. [source] External Validation of the Clinical Dehydration Scale for Children With Acute GastroenteritisACADEMIC EMERGENCY MEDICINE, Issue 6 2010Benoit Bailey MD Abstract Objectives:, The objective was to validate the clinical dehydration scale (CDS) for children with gastroenteritis in a different pediatric emergency department (ED) from where it was initially derived and validated. Methods:, A prospective cohort study was performed in a tertiary care pediatric ED over a 1-year period. A sample of triage nurses were trained in applying the CDS. The CDS consists of four clinical characteristics (general appearance, eyes, mucous membranes, and tears), each of which are scored 0, 1, or 2 for a total score of 0 to 8, with 0 representing no dehydration; 1 to 4, some dehydration; and 5 to 8, moderate/severe dehydration. Children 1 month to 5 years of age with vomiting and/or diarrhea who had the CDS documented at triage and a final diagnosis of gastroenteritis, gastritis, or enteritis were enrolled. Exclusion criteria included a chronic disease, treatment with intravenous (IV) rehydration within the previous 24 hours, visit to the ED for the same illness in the 7 days prior to arrival, and diarrhea of more than 10 days' duration. The primary outcome was the length of stay (LOS) in the ED from the time of seeing a physician to discharge, analyzed with a Kruskal-Wallis test. Results:, From April 2008 to March 2009, 150 patients with a mean (±SD) age of 22 (±14) months (range = 4 months to 4 years) were enrolled. Fifty-six patients had no dehydration, 74 had some dehydration, and 20 had moderate/severe dehydration. The median LOS in the ED after being seen by a physician was significantly longer as children appeared more dehydrated according to the CDS: 54 minutes (interquartile range [IQR] = 26,175 minutes), 128 minutes (IQR = 25,334 minutes), and 425 minutes (IQR = 218,673 minutes) for the no, some, and moderate/severe dehydration groups, respectively (p < 0.001). Conclusions:, The CDS has been further validated in children with gastroenteritis in a different pediatric center than the original one where it was developed. It is a good predictor of LOS in the ED after being seen by a physician. ACADEMIC EMERGENCY MEDICINE 2010; 17:583,588 © 2010 by the Society for Academic Emergency Medicine [source] | |||||||||||||