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Mediastinoscopy for diagnosing diseases of the lung other than primary carcinoma.

Mediastinoscopy is an efficient method of assessing lymphatic spread in carcinoma of the lung. It is also valuable in providing a definitive diagnosis of other lung diseases. At the Montreal Chest Hospital Centre diagnostic mediastinoscopy was performed in 60 patients with diseases of the lung other than primary carcinoma. All had preoperative radiologic evidence of hilar adenopathy. A definitive diagnosis was obtained in 91.7% of cases. Nonspecific adenitis was diagnosed in four patients and in none was there evidence of serious intrathoracic disease subsequently. Morbidity was minimal and there were no deaths. Mediastinoscopy is a safe, accurate and efficient aid in the evaluation of primary or secondary disease of the anterior intrathoracic lymphatic system.

Adolescent↗

[Pediatric retroperitoneal iliac abscesses (author's transl)].

11 cases of retroperitoneal iliac abscesses are reported in patients under seven years of age. Causes have been: sepsis in 2 cases, lumbar traumatism in 1, perforation of the iliac vein in 1, pararenal abscess in 1, following debridement of iliac adenitis in one child and by appendicular mass in another case. The etiology was unknown in the remaining cases. Gram positive germs such as Staphylococcus and Streptococcus predominated in the exudate cultures. The most important clinical manifestations have been: fever, painful mobilization of the psoas, pain in the iliac fossa, limping and antiallergic scoliosis. Among radiological findings obliteration of the psoas line, mass in the iliac fossa, ureteral displacement and vesical compression were the most outstanding. Breathing x-rays and echography were diagnostic procedures in our cases. Diagnosis and differential diagnosis are commented, together with treatment. Authors consider that surgical debridement and drainage and administration of antibiotics are the ideal therapeutical procedures in these processes.

Abscess↗

[Description of the female of a new Didymoizoidae: Gonapodasmius microovatus spec. nov].

In Megalaspis cordyla (L.) (Perciformes, Carangidae) from the Gulf of Aden Gonapodasmius microovatus spec. nov., a trematode of the family Didymozoidae is parasitizing in the body cavity. The only preserved specimen is a mature female. Description and differential diagnose is given together with a key of determination for the genus, also a review of the geographical distribution and the fish hosts of the species of the genus Gonapodasmius.

Animals↗

[Phlebectasia of the internal jugular vein post injury (author's transl)].

The authors present the case of a 14 year-old girl having the cervical deformity developed on the background of influenza and sore throat and was caused by an apparently minor sports injury, with vertebrocervical lesion and rupture of the inner wall of the jugular vein. The painful onset symptomatology, initially attributed to exacerbation of the anginous process and cervical adenitis, evolved towards phonation, deglutition, nervous and final respiratory disturbances. The progressive evolution and gravity of the clinical picture imposed craniocervical surgery, with exclusion of the lateral intramastoid sinus and resection of the extensive ectatic cervicoprevertebral pouch. The authors discuss the mechanism of the vascular lesion, the clinical picture, evolution, diagnosis and therapy, which totaly differed from classical descriptions of phlebectasia of the jugular vein.

Adolescent↗

General pathology of Kawasaki disease. On the morphological alterations corresponding to the clinical manifestations.

Systemic pathological alterations were studied in thirty-seven autopsied patients with Kawasaki disease. Systemic vasculitis was the most characteristic pathological finding and was present in all the patients. In addition to the vasculitis, there was a high incidence of inflammatory lesions in various organs and tissues: in the heart, endocarditis, myocarditis, and pericarditis; in the digestive system, stomatitis, sialoduct-adenitis, catarrhal enteritis, hepatitis, cholangitis, pancreatitis, and pancreas ductitis; in the respiratory system, bronchitis and segmental interstitial pneumonia; in the urinary system, focal interstitial nephritis, cystitis, and prostatitis; in the nervous system, aseptic leptomeningitis, choriomeningitis, gangliontis, and neuritis; in the hematopoietic system, lymphadenitis, splenitis, and thymitis. Dermatitis, panniculitis or myositis were also observed in some patients. Therefore, Kawasaki disease is a systemic inflammatory disease which mainly affects the cardiovascular system. These systemic inflammatory lesions are considered to correspond to the variegated clinical manifestaitions. The relationship between Kawasaki disease and infantile polyarteritis nodosa (IPN) were discussed, based on the clinicopathological characteristics.

Child↗

[Conceptual basis and diagnosis of primary hyperaldosteronism].

Primary aldosteronism comprises two different conditions, the tumoral form usually caused by an adenoma and the idiopathic form due to nodular hyperplasia of the two adenals. More rarely, an adenoma of the adrenal cortex, glucocorticosteroid-sensitive hyperplasia, and angiotensin-sensitive adenoma or an autonomous nodule transformed to primary tumoral hyperplasia, may be observed. Primary alderosteronism may be conceived as a spectrum of genetic abnormalities which express themselves either by hyperplasia or by a tumour. A defect in steroid genesis and prolonged stimulation of the cortex would lead to the formation of nodules which may become autonomous and generate a tumour. Hypertension may be isolated. Detection requires three sampling of serum potassium in all hypertensive patients, a study of the aldosterone-renin axis when the value is less than 3.6 mEq, or whenever the hypertension is severe or resistant to treatment. The diagnosis is made by the association of an increased plasma aldosterone level before getting up in the morning and a plasma renin unaffected by orthostatism. The choice of medical or surgical treatment depends on the uni- or bilateral anatomic substrate. Computerised tomography, very sensitive but not specific, like hormonal studies, often provides incomplete answers. Adrenalectomy is indicated in the presence of a mass of centimetric proportions with concordant results of the dynamic test. In other situations, investigations are continued with the search for an aldosterone gradient by selective venous sampling. This is very valuable to determine the lateralisation but fails in 25% of cases, and its results have to be compared with those of imaging techniques: CT scan, venography and, when necessary, scintigraphy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenoma↗

[Cysts of second branchial cleft: review of 32 operated cases].

The aim of this work was to analyze retrospectively the clinical features of 32 patients aged 23.9 years (21 female) with the histological diagnosis of second branchial cleft cyst. In 28 patients, the cyst was localized below the mandibular angle. The presenting symptom was a cervical tumor in 30 patients and pain in eight. Fourteen aspiration punctures was performed obtaining 8 purulent and 6 straw colored aspirates. The preoperative diagnosis was correctly made in only 19 patients; the principal confounding diagnosis was tuberculous adenitis. All patients were operated performing a complete cystectomy in 30 and partial cystectomy in two. Three patients had a surgical wound infection and the cysts recurred 5 months and 4 years after operation in the two patients subjected to partial cystectomy. The histological study revealed squamous epithelial with underlying lymphoid tissue. It is concluded that aspiration puncture is useful for the correct diagnosis and that the cyst must be completely eradicated to avoid recurrences.

Adolescent↗

Tuberculous pseudotumor causing biliary obstruction. Report of a case with diagnosis by fine needle aspiration biopsy and bile cytology.

Hepatobiliary tuberculosis is a rare but distinct clinical entity. We report an unusual case of biliary tract obstruction due to localized hepatic tuberculosis with periportal tuberculous adenitis. The lesion mimicked a malignancy clinically and radiologically. Fine needle aspiration biopsy revealed granulomas, epithelioid histiocytes and Langhans' giant cells. The cytodiagnosis was confirmed by identification of acid-fast bacilli in the bile cytology and isolation of Mycobacterium tuberculosis by culture. The patient responded to antituberculosis therapy. The usefulness of bile cytology in the diagnostic management of biliary tract obstruction is illustrated.

Bile↗

Tuberculous disease in a pediatric referral centre: 16 years experience.

Children with evidence of tuberculous disease registered at the TB Clinic, Institute of Child Health, Madras during the years 1977 to 1992 were analyzed. Progressive primary complex, is the commonest thoracic form of tuberculosis while tuberculous meningitis is the commonest extra thoracic form. The overall prevalence of various clinical forms of tuberculosis has decreased over the last 16 years. There is an increasing trend in the prevalence of progressive primary complex among the BCG vaccinated group. The prevalence of pleural effusion, bone tuberculosis and abdominal tuberculosis is almost same over the last 16 years and is more in the BCG non vaccinated children. In tuberculous adenitis there is no significant variation between the two groups. The occurrence of tuberculous meningitis is in the ratio of 1:3 among BCG vaccinated and non-BCG vaccinated children. Though the prevalence of miliary tuberculosis is negligible, it is significantly more in BCG non-vaccinated children. There is a tendency for slight decrease in overall mortality due to tuberculosis in the last 10 years but the mortality due to tuberculous meningitis continues to be the same over the past 16 years.

Abdomen↗

Clinical features, diagnosis, and treatment of tuberculosis in infants.

OBJECTIVE: Despite the recent resurgence of tuberculosis among children in the United States, no series of infants < 1 year of age with tuberculosis has been reported in the last 20 years. This study was undertaken to describe the epidemiology, clinical, and radiographic manifestations, and response to therapy in infants < 1 year of age with tuberculous disease. METHODS: The medical records were reviewed for all infants age 12 months or less with a diagnosis of tuberculosis and cared for at the Children's Tuberculosis Clinic at Ben Taub General Hospital in Houston, Texas between January 1, 1985 and June 30, 1992. RESULTS: Of the 47 infants identified, 51% were female. The median age at diagnosis was 8 months (range 3.5 to 12 months). Fifty-one percent of the infants were African-American and over one-third were Hispanic. All patients were born in the United States. Diagnosis resulted from the examination of an ill infant in 79% of cases, a case contact investigation of an adult suspected of having tuberculosis in 19%, and routine tuberculin skin testing in 2%. An adult with infectious tuberculosis who had contact with the infant was identified in 68% of cases. Intrathoracic disease alone was present in 70% of cases. Fourteen (30%) infants had extrapulmonary tuberculosis (11 central nervous system disease, 2 disseminated disease, and 1 cervical adenitis). Gastric aspirate cultures yielded Mycobacterium tuberculosis from 75% of the infants with isolated intrathoracic disease. Forty-five infants successfully completed therapy and only one death was directly related to tuberculosis. Forty-eight percent of the infants with pulmonary tuberculosis were treated with a 6-month regimen consisting of isoniazid and rifampin supplemented during the first 2 months by pyrazinamide. Eighteen infants received some twice weekly directly observed therapy mainly due to documented or suspected nonadherence. Treatment was well-tolerated; one patient (2%) developed hepatotoxicity due to isoniazid. No infant had a relapse or recurrence of disease in 6 months to 7 years follow-up for a median of 3 years (range, 6 months to 7 years). CONCLUSION: Most infants with tuberculosis are symptomatic at the time of diagnosis, and bacteriologic confirmation was obtained in 70% of cases. A contact investigation of the household should be initiated immediately when an infant is suspected of having tuberculosis because valuable information needed to establish the diagnosis and guide therapy in the infant may be obtained. Intensive 6-month and twice weekly directly observed therapy appear to be well-tolerated and effective for the treatment of pulmonary tuberculosis in infants.

Drug Therapy, Combination↗

Obstructive sialadenitis: a rat model.

Obstructive adenitis of major salivary glands is a common entity. Although the pathologic features are well recognized, the various cell types involved in the atrophy and subsequent regeneration of the obstructed salivary gland have been controversial. For this reason, an animal model of obstructive sialadenitis that induced atrophy in the rat parotid gland was developed. A clamp was devised that would occlude the main excretory duct of the gland inducing atrophy, but that, following removal, left the duct patent and allowed regeneration to occur. Both atrophy and regeneration were studied, and the results presented. The number and location of cycling acinar, intercalated, striated, and excretory duct cells were identified, using an antibody to proliferating cell nuclear antigen (PCNA). All cell types were induced to cycle during both the atrophy and regeneration phase, but the degree of cycling was more pronounced during regeneration. Three days after release of the duct obstruction, cycling acinar cells had increased 40-fold, while striated and intercalated ducts increased 6.5- and 5.0-fold, respectively. More importantly, peak cycling of acinar cells preceded, but paralleled, the increase in acinar cell composition of the gland. This model of obstructive sialadenitis indicates that all cell types are responsible for regeneration in the obstructed rat parotid gland.

Animals↗

CT manifestations of cervical tuberculous lymphadenitis.

Cervical tuberculous lymphadenitis is a commonly encountered disease, especially in Korea. Differentiation from other metastatic lymphadenopathies and benign conditions such as cystic neck masses is important. CT findings of tuberculous lymphadenopathy in the abdomen and thorax are frequently reported in the literature, though there are only a few articles concerning cervical tuberculous lymphadenopathy. The authors retrospectively analyzed CT findings of 42 cases with cervical tuberculous lymphadenitis regarding distribution, contour, enhancing pattern, changes in the adjacent fascial plane, and dermal and subcutaneous manifestations. We concluded that the following are suggestive of tuberculous lymphadenitis: the presence of conglomerated nodal masses with central lucency, thick irregular rim of contrast enhancement and inner nodularity, varying degree of homogenous enhancement in smaller nodes, dermal and subcutaneous manifestations of inflammation such as thickening of the overlying skin, engorgement of the lymphatics and thickening of the adjacent muscles, and a diffusely effaced fascial plane. There were only a few cases of central low densities with calcifications on CT scan. However, common CT patterns of tuberculous adenitis may also be seen in other diseases, such as lymphoma and metastatic lymphadenopathy, and a thorough clinical examination and detection of primary lesions may be more helpful in differentiating these lymphadenopathies.

Adolescent↗

[Microdoses of BCG vaccine for prophylaxis in bladder cancer stage T1].

A prophylaxis with a minidose of BCG Vaccine (1 mgr.) is performed in vesical instillation during one year, to 108 patients bearing bladder cancer in the stage T1. In the first month the instillations are once a week, each fifteen days the second and third month and then, once a month for one year. An 19.4% of recurrences is obtained with an general average observation time of 37.3 months as well as an important increase of muster populations of T lymphocytes and a positive test of dinitroclorobenzene. As complications we have obtained an inguinal BCG adenitis and in a few cases disury and frequency for two or three days. We conclude that the doses of the BCG vaccine used during the period of one year, is satisfactory in the reduction of recurrences and without important complications.

Administration, Intravesical↗

Childhood appendicitis. A clinical profile.

A study to assess the reliability of clinical symptoms and signs in 50 patients with a presumptive diagnosis of acute appendicitis is presented. The male to female ratio was 3: 2, with age ranging from 2 to 15 years. Abdominal pain was present in 42; tenderness was localized in 35, generalized in 11 and diffuse in 4 patients. Total leucocyte count was above 11,000/cu mm in 31, below 11,000/cu mm in 17 and above 18,000/cu mm in 2. Of the 48 operated patients, 8 had normal appendices and the diagnosis in them was Meckel's diverticulitis 3, ruptured ovarian follicle 2, mesenteric adenitis 2, and salpingo-oophoritis 1. Abdominal pain and right iliac fossa tenderness with contributory investigations are the most reliable indicators of acute appendicitis with a false positive rate of 16.66% only.

Abdominal Pain↗

Theophylline induced differentiation provides direct evidence for the deregulation of c-myc in Burkitt's lymphoma and suggests participation of immunoglobulin enhancer sequences.

Most of the evidence that supports the hypothesis that the c-myc gene is abnormally regulated in Burkitt's lymphoma (BL) is indirect. The putative abnormal expression of c-myc is likely, at least in part, to be a consequence of the usurpation of its regulatory sequences by immunoglobulin enhancer elements, which are invariably juxtaposed to c-myc by the translocations associated with this tumor (C. M. Croce, J. Erikson, A. Ar-Rushdi, D. Aden, and K. Nishikura, Proc. Natl. Acad. Sci. USA, 81: 3170-3174, 1984). We have developed a differentiation induction model system to examine this issue more directly. In a variety of non-BL cell lines, differentiation induction results in the down-regulation of c-myc (G. P. Studzinski, A. K. Bhandal, and Z. S. Brelvi, Proc. Soc. Exp. Biol. Med., 179: 288-295, 1985; Y. Matsui, R. Takahasi, K. Minara, T. Nakagawa, T. Koizumi, Y. Nakao, T. Sugiyama, and T. Fugita, Cancer Res., 49: 1366-1371, 1985; T. Mitchell, E. Sariban, and D. Kufe, Mol. Pharmacol., 30: 398-402, 1986; Z. S. Brelvi, and G. P. Studzinski, J. Cell. Physiol., 128: 171-179, 1986). Since BL is of B-cell origin, differentiation is associated with persistent or increased expression of immunoglobulin genes. Therefore, if c-myc and c-mu are coregulated in BL via immunoglobulin enhancer sequences, persistent or increased expression of the c-myc gene, rather than down-regulation, should occur in differentiated BL cells. Differentiation was induced in four BL cell lines with theophylline (7 x 10(-3) M), and mRNA was examined by Northern blot analysis. In all four BL lines studied (JD38, AG876, KK124, and Daudi), there was persistent or increased expression of both c-mu and c-myc genes (detected with a third exon c-myc probe), in contrast to the decreased expression of the c-myc gene observed in the three Epstein-Barr virus transformed lines studied (A3317, TC84, and CB34). In the BL cell line, JD38, the c-myc gene is truncated (the second and third exons are translocated to chromosome 14 while the first exon remains on chromosome 8). In this line, we demonstrated that theophylline induced differentiation results in down-regulation of the first exon while the level of expression of the translocated second and third exons remains unchanged or increases.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Actinomycosis of the neck: diagnosis by fine-needle aspiration biopsy.

A patient with actinomyces infection of the posterior neck was diagnosed by fine-needle aspiration biopsy. The lesion presented as a recurrent, firm, and indurated mass that was clinically diagnosed as adenitis and cellulitis and was thought to be a lymphoma 6 months after the onset of his illness. Smears and cell block sections of the aspirate showed characteristic colonies ("sulfur granules") of actinomyces. Subsequent regional lymph node biopsy revealed reactive lymphoid hyperplasia.

Actinomyces↗