The strange case of Ms Elizabeth Trevers who was affrighted to an astonishment.
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Biomedical subjects
Publications and source records attributed to F I Jackson.
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Tc-99m hexamethylpropylene amineoxime (HMPAO) is a novel radiopharmaceutical demonstrated to be a sensitive indicator of abnormalities of cerebral perfusion. Most reports in the literature have evaluated patients with gross perfusion deficits, such as cerebrovascular accidents, and with dementia, where patterns of diffuse perfusion deficit were reported comparable with those seen in PET studies. We report a patient in whom there was the rapid onset of dementia, with the HMPAO images demonstrating diffuse loss of cortical perfusion in a nonfocal, and nonsegmental, fashion. Correlation with postmortem examination demonstrates good concordance between the diffuse nature of HMPAO loss, and diffuse cortical necrosis throughout both cerebral hemispheres. The technique was shown to be more sensitive than transmission CT scanning in demonstrating the extent of the deficit, and it correlated closely with the functional deficits noted in the patient.
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Lymphoma of the breast is rare. To evaluate the radiologic imaging and clinical appearances of this condition, the authors studied, over a 26-year period, 20 patients (19 women) with primary lymphoma of the breast and 7 (all women) with secondary involvement. The right breast was affected in 14 cases. A wide spectrum of appearances was noted on mammography and ultrasonography, but the use of both techniques is indicated because lesions may be missed by either technique used alone.
Primary malignant lymphomas of the breast (PBL) are uncommon. The authors report the clinical, histologic, and immunoperoxidase findings on 20 cases recorded at the Alberta Cancer Registry over the last 23 years. These cases were then added to material on 257 cases abstracted from the literature and analyzed. It was found that there are two clinicopathologic types of PBL. The first affects pregnant or lactating women with bilateral, diffuse disease, is rapidly fatal, and corresponds histologically to a Burkitt's-type lymphoma. The second is unilateral at presentation and afflicts a broad age range, but primarily older women. This has a variable course only part of which is predicted by histologic grade and stage. Tumor size, treatment, and side of presentation were not found to be significant prognostic factors. Histologically, these tumors can be grouped into large cell B-cell lymphomas, monocytoid B-cell lymphomas (MBCL), and undifferentiated, some of which may be T-cell. Evidence suggesting that the MBCL of breast are the equivalent of the malignant lymphomas of the mucosa-associated lymphoid tissues (MALT) is reviewed. The breast is a hormone-dependent member of the MALT and therefore it is interesting that two of these tumors were strongly positive for estrogen receptors.
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Histologic proof from 62 sites in 58 patients in whom an ultrasonic abnormality was detected in the absence of palpable or mammographic evidence revealed no malignancy. It is suggested that decision to biopsy be made on clinical grounds.
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In this study the authors compare ultrasonography and radiography with clinical examination in the diagnosis of Peyronie's disease. They also review its clinical presentation. In contrast to previous studies they found no correlation between plaques found on ultrasonography or radiography and those found on clinical examination. They conclude that ultrasonography and radiography are not reliable in diagnosing Peyronie's disease.
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Several unusual complications of I-131 therapy for thyroid carcinoma are known. Two patients who developed a further unusual event that consisted of a palpable mass and cystic degeneration are described.
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