Pseudoaneurysm of the internal carotid artery: complication of deep neck space infection.
The authors describe a patient with a pseudoaneurysm of the internal carotid artery secondary to cervical adenitis.
Aneurysm↗
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[Cervical adenophlegmon (apropos of 57 cases)].
Neck adenitis remain a frequent occurrence in our areas. Within one year only, 57 cases were collected in the ORL department of University Hospital of Ouagadougou. Children were mostly affected (70% of cases) and the starting point or supposedly was mainly pharyngeal (67% of cases); streptococcus were the dominant microbes. Concerning the treatment, our preference was for wide antibiotherapy, in monotherapy but using wide spectrum, including staphylococcus aureus, due to its frequency in this pathology. But the primum movens remained the incision drainage. The post-operative period were regularly simple for our 57 patients.
Adolescent↗
[Tuberculosis of the otorhinolaryngologic region: laryngeal and extra-laryngeal forms].
BACKGROUND: The aim of the study was to assess all patients with ENT symptoms whose histologic and/or microbiologic diagnosis confirmed tuberculosis. METHODS: All the anatomopathologic studies performed in the ENT unit in the authors' hospital in which the presence of acid-alcohol resistant bacilli were observed. All cases of cervical adenitis were not included. RESULTS: Eighteen patients with the following localizations were studied: 14 laryngeal tuberculosis and 4 extra-laryngeal tuberculosis (2 oropharyngeal, 1 otic and 1 sinusal). In the laryngeal forms, all patients were male except for one, and all were smokers. The duration of the symptoms was greater than 3 months in all the cases. Unilateral cord involvement was most commonly found, and in 2 cases this was associated with carcinoma of the vocal cord. Twenty-nine percent did not present with coincident pulmonary tuberculosis. None of the extra-laryngeal forms showed pulmonary involvement. All the patients were women and only 1 was smoker, the symptomatology was greater than 3 months in all cases and all required biopsy for achieving diagnosis. The evolution with medical treatment was favorable in all cases. During the same time period, 2300 cases of pulmonary tuberculosis were diagnosed in the authors' hospital. CONCLUSIONS: Tuberculosis of the upper respiratory tract is infrequent. Pulmonary involvement is common, although in this series this was only found in 71% of all laryngeal forms. Diagnosis is difficult, except in cases of coinciding pulmonary involvement and usually requires surgery for biopsy. Response to medical treatment is usually good.
Adult↗
Biopsy of labial salivary glands and lacrimal glands in the diagnosis of Sjögren's syndrome.
OBJECTIVE: To determine the diagnostic value in Sjögren's syndrome (SS) of evaluating the presence of focal adenitis in labial salivary gland (LSG) and lacrimal gland (LG) biopsy specimens. METHODS: We studied 105 cases with suspected SS and performed biopsies prospectively. The diagnostic criteria of Fox, et al were followed. The Chisholm-Mason grading standard and Greenspan focus score were used for evaluation. RESULTS: Epimyoepithelial islands and severe lymphocyte infiltration with germinal centers were observed only in LG biopsy specimens (5.9 and 3.5%, respectively). The lymphocytic focus scores of LG (2.5 +/- 2.1/4 mm2) were significantly higher than those of LSG specimens (1.3 +/- 1.1/4 mm2) in 23 cases with both biopsy results (p < 0.05). Six of the 32 LSG biopsies were normal while their LG biopsies were significantly higher. Conversely, 5 of the 32 LG biopsies were aided by corresponding LSG biopsies, since in LG biopsies no glandular tissue was obtained. Evaluation of both specimens for the same patient was significantly more effective in diagnosing SS than using either specimen alone (p < 0.01). CONCLUSION: LG biopsy specimens have a more evident histopathology than LSG biopsy specimens. We recommend that both LSG and LG biopsies be performed in patients with suspected SS to reduce false negative results and improve diagnostic accuracy.
Biopsy↗
Endoscopic diagnosis and management of hepatobiliary tuberculosis.
Primary hepatobiliary tuberculosis is difficult to diagnose and treat. We describe a woman with obstructive jaundice, a common hepatic duct stricture, and granulomatous hepatitis diagnosed with biliary tract tuberculosis when acid-fast bacilli were found in bile aspirated during endoscopic retrograde cholangiopancreatography (ERCP). The hilar stricture resulted from either primary biliary tuberculosis or secondary inflammation related to tuberculous periportal adenitis and persisted despite adequate medical treatment for tuberculosis, apparently the result of postinflammatory stenosis. After 20 months, the patient had persistently elevated bilirubin due to the stricture, and liver biopsy revealed early secondary biliary cirrhosis. Placement of a permanent metal biliary stent produced excellent results. Both diagnosis of hepatobiliary tuberculosis by bile aspirate and treatment of a biliary stricture with a permanent metal biliary stent are newly described advances in the management of biliary tuberculosis made possible by ERCP.
Bile Ducts, Intrahepatic↗
Silicone granulomatous lymphadenopathy and siliconomas of the breast.
In the present study, two histologically-distinct cases of granulomatous lymphadenitis induced by dimethylpolysiloxane (silicone polymer) implants were studied. Four and six years after implant, and following surgery for breast cancer, painful homolateral axillary adenopathies were observed and biopsied. In both cases, histological examination led to a diagnosis of "silicone-induced granulomatous adenitis" requiring removal of implants. Foreign-body granulomas (siliconomas) were observed in surrounding tissue with no apparent rupture of implant capsules; however, visible retraction, hardening and scattered calcifications were noted. The presence of silica was revealed by incineration of a number of biopsied lymph nodes, a technique not hitherto used in the study of this pathology. A review is offered of the literature available.
Breast↗
[BCG vaccines for the prevention of tuberculosis in the world].
The BCG vaccines will celebrate the 100th anniversary of their discovery in a decade at the beginning of the next century since Albert Calmette and Camille Guerin had presented it before the Academie des Sciences in 1908. At present tuberculosis kills more people than any other infectious disease about 3 million people a year, including almost 300,000 children under 15, and is producing over 7,000 deaths and over 24,000 new cases every day. Therefore, WHO declared a global health emergency in 1993. More worse, recently multi-drug resistant tubercle bacilli are emerging rapidly making TB patients incurable. Under these situations we need a potent anti-tuberculosis vaccine. So first of all, we must check the century-old BCG before proceeding further. At moment, the BCG vaccines are being used worldwide in the largest quantities in the world, but still most controversial vaccines anywhere. I would like to describe here their success and failure in the combat against the white plague. 1. The Expanded Programme on Immunization (EPI). In 1974, when the EPI was launched by WHO, less than 5% of the world children were immunized against six infectious diseases including tuberculosis. In 1995 statistics, BCG gave the highest vaccination coverage, 87% higher than any other 5 vaccines of EPI for children. The BCG in EPI must have saved a lot of infants as the vaccine, has been proved to be most effective against the blood-born tuberculosis of child type. 2. The efficacy of BCG vaccination against tuberculosis. Results of each 10 of randomized controlled trials (RCT) and Case-control studies (CCS) showed the protective efficacy against tuberculosis as uncertain, unpredictable, as protective efficacy varied from 80% to 0%. More recently, a Meta-analysis of selected papers on BCG field trials which were so far collected. They recalculated vaccine protective effect separately for pulmonary TB and for meningeal/miliary TB in the trials. As the result, it was found that protective effect against pulmonary TB could not be calculated, but protective effect against meningeal and miliary TB was calculated as 86%, 75% respectively, in RCT and CCS, being higher than against pulmonary TB. 3. The duration of BCG efficacy against tuberculosis was confirmed to continue for 15 years after vaccination. The incidence of every form of tuberculosis decreased steeply during the 15 years following vaccination. 4. BCG revaccination. A WHO statement was issued in 1995 mentioning that there is no definitive evidence that repeated BCG vaccination confers additional protection against tuberculosis. Therefore WHO has not recommended to repeat BCG vaccination because of no scientific evidence to support this practice. Multiple BCG revaccinations are not indicated in any persons. 5. Complications with BCG Second IUATLD study (1988) on complications induced by BCG was reviewed, especially following two points: 1-2) Regional suppurative lymphadenitis 3) Generalized lesions: fatal cases 1-2 Several African regions had experienced that the risk of outbreak of suppurative BCG lymphadenitis was low for vaccines with Glaxo and Japanese strains, but much higher for vaccines with Pasteur. This experience in nineteen eighties has led EPI to replace the Pasteur BCG vaccine with less reactogenic BCG, Japanese or Glaxo BCG to solve the outbreak of suppurative adenitis complication. 3 At moment, the only contra-indication of EPI BCG vaccination is symptomatic HIV infection (AIDS), but in the future asymptomatic HIV infection should be placed on alert, because fatal BCG generalized disseminations have already been experienced by HIV positive vaccinees although in a few cases in USA. 6. BCG seed lots for use of vaccination in the world. Nearly 10 seed lots (BCG) are being used in the world at present. However, they are more or less different each other in various characteristics: morphological, biochemical, biophysical, immunological, vaccinological and so on. None of them is the same
BCG Vaccine↗
[Cervical lymphadenitis caused by non-tuberculous mycobacteria. A case report].
Cervical lymphadenitis produced by non-tuberculous mycobacteria (NTM) is gaining in importance and should be included in the differential diagnosis of cervical masses, particularly in immunodepressed children and patients. The treatment of choice and diagnostic test are discussed. A case of primary cervical adenitis by NTM is reported and the management is discussed in the light of recent bibliography.
Anti-Bacterial Agents↗
[The problem of functional achlorhydria].
It was examined whether in anatomically intact specific adenic parenchyma of the gastric mucosa achlorhydria can persist after maximal stimulation or whether there is support to the conception of functional achlorhydria ("functional anacidity") furthermore. Relating to the anatomic structure of the gastric mucosa secretion of chloric acid was studied after submaximal and maximal stimulation in 101 cases. It was shown that there is no correlation between the morphology and the secretion of chloric acid in anatomically intact gastric mucosa after submaximal stimulation. In 18 cases out of 28 only the secretion of acid was in correspondence to the histological condition. In two cases out of 37 with atrophic gastric mucosa diverging results were found. After maximal stimulation with histamine chloride and pentagastrine one out of two cases with histologically intact mucosa showed normochlorhydria after seven days, whereas the second case remained achlorhydric. These results must be interpreted as functional achlorhydria. Submaximal stimulation of gastric secretion as it is practised today does not allow corresponding consequences concerning the morphological condition of the gastric mucosa. Discrepant results are found especially in histologically normal mucosa. There is more congruence in atrophic gastric mucosa.
Achlorhydria↗
Complicated varicella zoster infection in 8 paediatric patients and review of literature.
BACKGROUND: This is a study of complicated varicella zoster infection in paediatric patients. AIM: To find out the number of patients with such complications, the types of complications and their outcome. METHOD: This involved a retrospective review of the case records of 8 patients who presented to our unit over a 12-month period (Jan-Dec 96). All patients were previously well without any underlying immunodeficiency. Varicella zoster (VZ) infection was confirmed by VZ immunofluorescence from vesicular fluid. RESULTS: CMS complications accounted for 6 of the 8 cases. Of these, 3 presented with encephalitis, 2 with cerebella ataxia and 1 with aseptic meningitis and cerebella ataxia. Of the non-CNS cases, 1 presented with glomerulonephritis with superimposed staphylococcus infection of skin ulcers; the other had disseminated VZ infection with haemorrhagic vesicles, hepatitis, ileus with mesenteric adenitis and disseminated intravascular coagulation. OUTCOME: The patient with disseminated VZ infection and multiple organ involvement died 5 days after a stormy course. One patient with encephalitis who had status epilepticus for 2 hours had behavioural problems and poor memory. The remaining 6 patients had no sequelae. CONCLUSION: VZ infection usually a minor illness, can result in serious life-threatening complications in previously healthy patients.
Cerebellar Ataxia↗
Epidemiology of childhood tuberculosis in a hospital setting.
A study of two hundred cases of tuberculosis over a span of two years was carried out at the pediatric department of a hospital in Islamabad. The diagnosis was based upon history, clinical examination, chest and other relevant radiography, Mantoux test, erythrocyte sedimentation rate (ESR) and where necessary cerebrospinal, pleural and ascitic fluid examinations and lymph gland histopathology were done. An equal number of male and female children upto 12 years of age were enrolled. The children usually presented with fever, cough, weight loss or failure to thrive and pallor. The most commonly affected age group was between 2-5 years and pulmonary tuberculosis was the most frequent diagnosis followed by tuberculous adenitis.
Age Factors↗
Pseudoappendicitis preceding infectious mononucleosis.
In patients with infectious mononucleosis, abdominal pain is usually attributed to visceral enlargement. A teenage girl with symptoms of appendicitis was found at laparotomy to have mesenteric adenitis. Postoperatively, she developed classic features of Epstein-Barr virus (EBV)-induced mononucleosis. The lymphoproliferation characteristic of EBV infection can cause severe localized abdominal pain that predates the onset of mononucleosis.
Abdomen, Acute↗
The evaluation of pharmacologic agents on composite graft survival.
This study assessed the efficacy of various pharmacologic agents in improving composite graft viability in 60 New Zealand white rabbits given bilateral auricular composite grafts. Treatments included methylprednisolone preoperatively and for 3 days postoperatively or for 7 days postoperatively only; chlorpromazine, dimethylsulfoxide, or superoxide dismutase preoperatively; or indomethacin preoperatively and for either 3 or 7 days postoperatively. Four treatment modalities yielded a statistically significant decrease in percentage of necrosis. Methylprednisolone, when given preoperatively and continued postoperatively, produced the greatest increase (77%) in composite graft tissue survival. Dimethylsulfoxide, chlorpromazine, and indomethacin for 3 days were also effective, but to a much lesser extent. It is speculated that these agents may help stabilize cell membranes during the anoxic phase of plasmic imbibition and minimize cellular edema until revascularization can occur.
Animals↗
Gene profiling in spinal cord injury shows role of cell cycle in neuronal death.
Spinal cord injury causes secondary biochemical changes leading to neuronal cell death. To clarify the molecular basis of this delayed injury, we subjected rats to spinal cord injury and identified gene expression patterns by high-density oligonucleotide arrays (8,800 genes studied) at 30 minutes, 4 hours, 24 hours, or 7 days after injury (total of 26 U34A profiles). Detailed analyses were limited to 4,300 genes consistently expressed above background. Temporal clustering showed rapid expression of immediate early genes (30 minutes), followed by genes associated with inflammation, oxidative stress, DNA damage, and cell cycle (4 and 24 hours). Functional clustering showed a novel pattern of cell cycle mRNAs at 4 and 24 hours after trauma. Quantitative reverse transcription polymerase chain reaction verified mRNA changes in this group, which included gadd45a, c-myc, cyclin D1 and cdk4, pcna, cyclin G, Rb, and E2F5. Changes in their protein products were quantified by Western blot, and cell-specific expression was determined by immunocytochemistry. Cell cycle proteins showed an increased expression 24 hours after injury and were, in part, colocalized in neurons showing morphological evidence of apoptosis. These findings suggest that cell cycle-related genes, induced after spinal cord injury, are involved in neuronal damage and subsequent cell death.
Animals↗
Birth prevalence and pattern of osteochondrodysplasias in an inbred high risk population.
BACKGROUND: Define the pattern and birth prevalence of the different types of osteochondrodysplasias in newborn infants in the United Arab Emirates (UAE) population, which is highly inbred and where termination of pregnancy is not accepted. METHODS: All infants with a birth weight of 500 gm and above in the three hospitals in Al Ain Medical District of the UAE were studied prospectively over a period of 5 years. For each live birth or stillbirth with suspected skeletal dysplasia, a detailed clinical and radiological examination was carried out. Pregnancy history and information regarding parental age, ethnic origin, family history, and level of consanguinity were obtained and a pedigree was constructed. RESULTS: Among the 38,048 births during the study period, 36 (9.46/10,000 births) had some type of skeletal dysplasia. Eighteen cases were attributed to autosomal recessive genes (4.7/10,000 births), 10 were due to apparent new dominant mutations (2.62/10,000), five were autosomal dominant type (1.3/10,000) and one was X-linked dominant type (0.26/10,000). In three cases, inheritance was unknown. The most common recessive type of skeletal dysplasia in our series was fibrochondrogenesis (1.05/10,000), followed by chondrodysplasia punctata (0.78/10,000). The birth prevalence rate of skeletal dysplasia doubled in the last 2 years of the 5-year observation period (6.74/10,000 in 1996 vs. 12.86/10,000 in 1999, and 13.45/10,000 in 2000). This increase involved cases caused by new dominant mutations, and occurred mainly in the first half of 1999. CONCLUSION: This prospective study has identified a high birth prevalence of skeletal dysplasia, and risk factors are postulated. These findings represent an accurate birthprevalence figure and a useful baseline for this group of birth defects in the UAE.
Adult↗
Correlation of Web usage and exam performance in a human anatomy and development course.
Course materials for a Human Anatomy and Development Course were placed on the World Wide Web (WWW). The materials included a lab manual, lecture notes and slides, faculty-generated atlases, Web links, and examinations. The lab manual, lecture notes, and atlases were also provided as black-and-white hardcopy. The Office of Education assigned students a code name that allowed them to use the Web site and take exams anonymously. Student Web use was tracked and correlated with their performance on the final examination. Overall use patterns revealed that most students used the Web site to prepare for examinations, but not for daily studying. Old examinations were the most accessed documents; lecture notes were the least accessed. The access patterns of the students with top 20, middle 20 (closest to the mean), and bottom 20 scores on the final examination were compared. In general, there was little difference between the middle and top groups. Students in the bottom group used computer resources significantly less than the other groups. In a second analysis, the 10 students who used the Web site most frequently scored below the mean. The study suggests that interactive exercises will be heavily used, but that the preparation of all course materials for the WWW may not be an efficient use of institutional resources.
Achievement↗
Characterization of Hprt mutations in cDNA and genomic DNA of T-cell mutants from control and 1,3-butadiene-exposed male B6C3F1 mice and F344 rats.
A multiplex PCR procedure for analysis of genomic DNA mutations in the mouse hypoxanthine-guanine phosphoribosyltransferase (Hprt) gene was developed and then used with other established methods for the coincident identification of large- and small-scale genetic alterations in the Hprt gene of mutant T-cell isolates propagated from sham- and 1,3-butadiene (BD)-exposed mice and rats. The spectra data for RT-PCR/cDNA analysis and multiplex PCR of genomic DNA from Hprt mutants were combined, and statistical analyses of the mutant fractions for the classes of mutations identified in control versus exposed animals were conducted. Under the assumption that the mutant fractions are distributed as Poisson variates, BD exposure of mice significantly increased the frequencies of (1) nearly all types of base substitutions; (2) single-base deletions and insertions; and (3) all subcategories of deletions. Significantly elevated fractions of G:C-->C:G and A:T-->T:A transversions in the Hprt gene of BD-exposed mice were consistent with the occurrence of these substitutions as the predominant ras gene mutations in multiple tumor types increased in incidence in carcinogenicity studies of BD in mice. BD exposure of rats produced significant increases in (1) base substitutions only at A:T base pairs; (2) single-base insertions; (3) complex mutations; and (4) deletions (mainly 5' partial and complete gene deletions). Future coincident analyses of large- and small-scale mutations in rodents exposed to specific BD metabolites should help identify species differences in the sources of deletion mutations and other types of mutations induced by BD exposures in mice versus rats.
Animals↗
Chromosomes of human hepatoma cell lines.
The karyotypes of three human hepatoma cell lines Hep G2, Hep 3B and PLC/PRF/5 were investigated by G- and C-banding techniques. In addition to ploidy changes, typical for most carcinoma cell lines, certain markers were found that remained stable throughout passage of these cultures. Chromosome I is involved in multiple translocations, resulting in at least three copies of the chromosome I heterochromatin region in each cell line. Inversion in the 9qh region is also seen. In addition, each of the cell lines consistently contains trisomy of 17q. The rearrangements of chromosome I are most striking in the Hep 3B and PLC/PRF/5 cell lines, which are derived from human hepatocellular carcinomas and contain integrated copies of the hepatitis B viral genome. These two cell lines are characterized by the presence of at least five copies of the I (p13 leads to q21) region that result from multiple deletions and/or translocations; by consistent trisomy and polymorphism of the 9qh region; and by trisomy of chromosome 10 (also involved in rearrangements). The Hep G2 and Hep 3B cell lines behave functionally as highly differentiated liver parenchymal cells and are karyologically distinguishable from PLC/PRF/5 both by the presence of trisomy of 6 (pter leads to q14) and by the finding that one of the homologues of chromosome 15 is 15q+.
Carcinoma, Hepatocellular↗