Use of a cutting balloon for dilatation of a resistant venous stenosis of a hemodialysis fistula

In a 71-year-old patient with a Brescia-Cimino hemodialysis fistula, high-pressure balloon dilatation failed to open the stenosis completely and a constant waist of the balloon was found. The use of a 3.5-mm coronary cutting balloon (Barath balloon) was helpful in preparing the stenosis for subsequent successful dilatation.     

Death of a child following a superstitious ritual of exorcism

IntroductionDiseases, especially those related to the psyche produced by demons, are an accepted belief in many communities. This paper elaborates on the death of a child, a victim of an exorcism ritual, and calls for adequate awareness and preventive measures.Case reportThe deceased, a 9-year-old child, was taken by her mother to an exorcist to 'expel a demon from her body. The exorcist caned the child for two days while giving 'water' to drink. On the ^second day, the child lost consciousness and was pronounced dead on admission. On direct questioning, it was revealed that the child had been made to consume some medicinal syrups forcefully by the mother and the exorcist. The autopsy revealed multiple abrasions, tram-line contusions and burns on the body. There was mottling and consolidation in the lungs. Blood-stained secretions were found in the trachea, bronchi, and stomach. Musculoskeletal dissection revealed subcutaneous haemorrhages and muscular contusions over the buttocks and limbs. Histology revealed evidence of well-established aspiration pneumonia. There was no other significant pathology, especially no evidence of acute kidney injury due to rhabdomyolysis. Toxicological analysis was negative for common poisons, therapeutic drugs, and heavy metals. The cause of death was concluded as aspiration pneumonia in a child subjected to physical violence.ConclusionWith the forceful feeding of the syrup, the child can have aspiration, resulting in aspiration pneumonia. At the same time, it appears that even after the child became symptomatic, she had not been brought for medical treatment but had continued with the same exorcistic therapy. While the caregivers become responsible for the child's death, the lessons to be learnt are enormous. Thus, banning such practices against children is a need of the hour.     

CT-Guided Placement of a Drainage Catheter Within a Pelvic Abscess Using a Transsacral Approach

A 66-year-old man underwent CT-guided drainage catheter placement within a pelvic abscess with a diameter of 46 mm. We performed the drainage by a transsacral approach because it was considered the safest and most feasible approach. An 8G bone marrow biopsy needle was used to penetrate the sacrum to create a path for subsequent drainage catheter insertion. After withdrawal of the biopsy needle, a 6 Fr catheter was advanced into the abscess cavity through the path using the Seldinger technique. Except for bearable pain, no procedure-related complications occurred. Twenty-nine days after the placement, the catheter was withdrawn safely and the abscess cavity had shrunk remarkably.     

Death of a seven-month-old child in a washing machine: a case report

The authors present a case which brings out a unique modality of child homicide by placing the baby in a washing machine and turning it on. The murder was perpetrated by the baby’s mother, who suffered from a serious depressive disorder. A postmortem RX and then a forensic autopsy were performed, followed by histologic examinations and toxicology. On the basis of the results of the autopsy, as well as the histology and the negative toxicological data, the cause of death was identified as acute asphyxia. This diagnosis was rendered in light of the absence of other causes of death, as well as the presence of typical signs of asphyxia, such as epicardial and pleural petechiae and, above all, the microscopic examinations, which pointed out a massive acute pulmonary emphysema. Regarding the cause of the asphyxia, at least two mechanisms can be identified: drowning and smothering. In addition, the histology of the brain revealed some findings that can be regarded as a consequence of the barotrauma due to the centrifugal force applied by the rotating drum of the washing machine. Another remarkable aspect is that we are dealing with a mentally-ill assailant. In fact, the baby’s mother, after a psychiatric examination, was confirmed to be suffering from a mental illness—a severe depressive disorder—and so she was adjudicated not-guilty-by-reason-of-insanity. This case warrants attention because of its uniqueness and complexity and, above all, its usefulness in the understanding of the pathophysiology of this particular manner of death.

     

Implementation of a restraint policy: a case study

A no-restraint policy was implemented for 50 elderly residents of a small nursing home to determine if decreasing the use of restraints would increase falls. The decision not to restrain posed a conflict between protection of the patient and staff beliefs. The results of the study seem to contradict popularly held beliefs concerning restraining the institutionalized elderly to decrease falls. During the 2-year period, only two patients sustained minor abrasions due to falls, and one patient experienced a fractured hip.     

MR of a nasal glioma in a young infant

We describe MR findings of a nasal glioma in a 5-week-old male infant with feeding difficulties and symptoms of respiratory distress. Endoscopic examination revealed a soft tissue mass in the nasal cavity. In T1- and T2-weighted images, the gyral structure of grey matter was visible. In T1-weighted images, a tissue component with a lower signal intensity equal to that of white matter was also well distinguishable. Edge enhancement of the tumour was due to the nasal mucosal epithelium covering the tumour. MR images were useful to rule out intracranial extension of the nasal cavity lesion and the brain, thus excluding the diagnosis of encephalocele. The lesion was excised and histologically characterized as heterotopic brain tissue.     

Optimization of a teleradiology system between two geriatric hospitals and a radiology department of a CHU

The routine use of a 64 kb/sec Numeris network requires that a compromise be reached between image quality and time required for image transfer. Our goal was to present our experience and describe our choices when reporting examinations for two geriatric hospitals located at a short distance from our radiology department. Different digitization parameters were tested (resolution, compression) for 10 plain films corresponding to the usual clinical situations: abdominal X ray, chest X ray, wrist, spine and pelvis X rays. A subjective analysis of the global quality and of the quality of a region of interest enlarged twelve times has been performed. After result analysis, our choices were: digitization using 75 or 150 DPI and systematic use of a reversible compression format. This system proved satisfactory for both clinicians and radiologists; since its implementation, 1,800 files have been reviewed.     

Identification of a cannabimimetic indole as a designer drug in a herbal product

A cannabimimetic indole has been identified as a new adulterant in a herbal product being sold illegally in Japan for its expected narcotic effect. Liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry analyses indicated that the product contained two major compounds. One was identified as a cannabinoid analog (1RS,3SR)-3-[4-(1,1-dimethyloctyl)-2-hydroxyphenyl]cyclohexan-1-ol (1) by direct comparison with the authentic compound, which we reported previously. The other compound (2) showed a molecular weight of 341 daltons, and accurate mass spectral measurements showed its elemental composition to be C₂₄H₂₃NO. Both mass and nuclear magnetic resonance spectrometric data revealed that 2 was 1-pentyl-3-(1-naphthoyl)indole [or naphthalen-1-yl-(1-pentylindol-3-yl)methanone] being identical to JWH-018, which was synthesized by Wiley and coworkers in 1998. This compound was reported as a potent cannabinoid receptor agonist possessing a pharmacological cannabimimetic activity.     

Migrating third molar: a report of a case

Pathologic migration is an abnormal change in the position of a tooth within the dental arch. There are many etiologic factors associated with this phenomenon, but the exact cause is often difficult to diagnose. The following is a report of a 42-year-old man exhibiting a unique form of bilateral migration of his mandibular third molars. He was asymptomatic and unaware of this occurrence. The morbidity to remove these teeth was deemed too great to justify extraction. Biopsy of the overlying tissue associated with a left-impacted third molar revealed no significant pathologic process other than inflammation and some hyperplasia within the dental follicle. Histologic-radiographic correlation was inconclusive in determining whether epithelium from pericoronal soft tissue involving the right third molar was from a hyperplastic dental follicle or a small dentigerous cyst. It is speculated that the ultimate cause of the migration of the third molars was severe, aggressive periodontal disease of the adjacent molars.     

Closure of a ureterocutaneous fistula with a covered stent-graft

A 74-year-old woman developed retroperitoneal fibrosis after aortic surgery for a left common iliac artery aneurysm. On the 5th day after repair, a left groin ureterocutaneous fistula developed. Because of the presence of a hostile surgical bed, the fistula was treated with percutaneous nephrotomy and double J stent insertion. Despite proximal control for more than 1 year, the fistula persisted. She was referred to the interventional radiology department for exchange to a nephrostomy with ureteral embolization. Rather than perform embolization of the ureter, we successfully repaired the fistula with a covered stent-graft. The patient was seen again 1 year after stent-graft placement. Output continues to fluctuate but never exceeds 5 mL per day.     

Constrictive pericarditis: a cause of exertion-induced dyspnea in a soldier with a prior sternotomy

Diagnosing the underlying etiology of dyspnea on exertion in adults can be challenging, often requiring the clinician to distinguish cardiac or pulmonary pathological conditions from metabolic, neurological, or hematological conditions or from chest wall abnormalities. We report such a case involving a 29-year-old, male, active duty Army soldier. With a history of a median sternotomy, symptoms of right- and left-side heart failure, and examination findings suggesting elevated right atrial pressure, pericardial disease was pursued. Echocardiography and cardiac catheterization revealed constrictive physiological features, namely, elevation and near-equalization of right- and left-side pressures and ventricular interdependence, whereas computed tomography illustrated pericardial thickening, ultimately leading to the diagnosis of constrictive pericarditis. The patient was treated with a complete pericardiectomy, leading to symptom resolution and improved exercise capacity. This case report of a rare condition offers a concise etiological and physiological overview of constrictive pericarditis and demonstrates an effective multimodal diagnostic approach. The scientific evidence provided may assist general practitioners in making decisions to differentiate this clinical condition from similar cardiac or cardiopulmonary conditions.     

CT in a case of intracranial penetration of a pencil

A case is reported of an unusual foreign body, a pencil, penetrating the right temporal lobe through the squamous temporal bone in a fall. Wood has low attenuation coefficients, so that the appropriate CT examination includes multiple window settings to permit accurate assessment of bone fragment displacement as well as recognition of detached wood splinters. CT scanning and early surgery are important steps in the management of these injuries to reduce significantly the overall mortality as well as immediate and long term complications. The necessity for meticulous surgical technique when removing the foreign body is stressed as retained wood can not easily be visualized against the hypodense background due to postoperative changes.     

Intermittent hydronephrosis as a cause of a false-negative pressure-flow study

A case is reported of a negative pressure-flow study in a patient with intermittent hydronephorosis. This is the first known report of a properly performed pressure-flow study failing to diagnose obstruction due to the intermittent nature of the obstruction itself. This case also supports the concept that the ureteropelvic junction (UPJ) can be intrinsically normal in patients with intermittent hydronephrosis secondary to a crossing renal vessel. It also reaffirms the need to study these patients while they are symptomatic.     

Glue-sniffing as a cause of a positive radio-isotope brain scan

Convulsions are a known complication of the acute intoxicant effects of solvent abuse. A radio-isotope brain scan done 9 months following status epilepticus secondary to toluene inhalation, in a previously normal school-boy, demonstrated several wedge-shaped areas of increased uptake, in both cerebral hemispheres, consistent with infarcts. It is worth remembering that a positive brain scan in a young person, with recent onset of epilepsy, may be due to glue-sniffing.     

Nonunion of a first rib fracture in a gymnast

Isolated fracture of the first rib is uncommon, but has been reported to occur in sports such as basketball, baseball, and dancing. It has not been reported to occur in gymnasts. Usually, these fractures heal with an adequate period of rest. Rarely do first rib fractures become nonunions. They have been felt to be asymptomatic and are usually found incidentally on routine chest roentgenograms. Symptomatic nonunion of a first rib fracture has not been reported previously. Our patient did not respond to nonoperative treatment and required surgical intervention to alleviate her symptoms. We agree that most fractures of this type heal without complications. However, if a persistently symptomatic nonunion ensues, we suggest transaxillary resection of 90% or more of the first rib.     

Responsibilities of a veterinary augmentation package in support of a contingency operation

A veterinary augmentation package (VAP) was assigned to the 212th Medical Treatment Facility supporting Task Force Hawk outside Tirana, Albania, from April 15 to July 4, 1999. The VAP's mission was to provide level I and II veterinary care, including emergency treatment, stabilization, and evacuation of military working dogs, and to ensure food safety and public health. This mission allowed the VAP to act as a force multiplier and to play an integral role in force protection. In the first 30 days of the operation, the VAP was confronted with animal issues concerning housing of the military working dogs, no access to emergency equipment, antiquated sets, kits, and outfits, and stray animal control. The food safety mission initially entailed inspections of operational rations and inspection of local sources for food procurement. Operational rations were replaced by A-rations, which required a central ration breakdown point to facilitate disbursement of food. The final step was to initiate the prime vendor program so that food was delivered directly to the dining facilities. Inspections of the port at which the food was arriving and a close association with preventive medicine personnel ensured a successful prime vendor operation. Veterinarians on future deployments should be prepared to supplement sets, kits, and outfits, pack an aid bag, and work closely with preventive medicine personnel, all while possibly living under the austere conditions of a combat zone.     

Arthroscopic reconstruction of a ruptured patellar tendon: a technical note

A traumatic patellar tendon rupture of a 35-year-old, otherwise healthy male was reconstructed with semi-tendinosus and gracillis tendons. Tendon grafts were harvested with an open-ended tendon stripper without dissecting them free from their tibial insertion. A transpatellar tunnel was drilled appropriate to the tendon size and a passing pin was used across the length of the patella. Graft bundles were passed in a standard fashion, traversing through the midst of the distal part of the patellar tendon via a beath pin with a loaded looped suture. The endo-button device was then flipped and fixed as an anchor. The patella was positioned at the original placement under arthroscopic visualization and the free ends of the hamstring tendons were attached to a post-fixation screw through the Krackow sutures. Tendon grafts were gathered on the tuberositas tibia and fixed with two additional staples. The patient could flex his knee up to 130 deg at the 3-month follow-up. It was demonstrated that arthroscopic reconstruction of a ruptured patellar tendon may be the optimal surgical choice to minimize trauma and begin early rehabilitation.     

某部潜艇人员长航期间膳食结构调查分析

目的 了解某部潜艇人员长航期间膳食营养状况和存在问题,为保障潜艇官兵健康以及制定军人营养素供给量、食物定量标准提供依据.方法 膳食调查采用记帐法,能量消耗采用能量平衡法.结果 (1)猪肉、牛羊肉、脏腑、禽蛋、鱼虾、乳粉、豆类及制品、食糖、蔬菜、木耳、海带、紫菜摄入量偏低.(2)热能71.1%来源于植物性食物,而摄入动物性蛋白质占摄入蛋白质总量的50.1%,符合军标要求,动物性脂肪占摄入脂肪总量的69.9%,超过军标要求.(3)人均每日维生素A、维生素E和维生素B1的摄入量明显低于军标,胆固醇摄入量明显超过军标.另外,人均每日摄人大量钠.结论 受调查的潜艇部队长航期间能量和多数营养素的摄入量能达到军标要求,维生素A、维生素E和维生素B1的摄入量偏低,胆固醇摄入量偏高,应增加牛羊肉、蔬菜、牛奶、禽蛋、鱼虾等水产品的供应,减少动物脂肪的摄人,减少食盐等调味品的摄入.     

Development of a single-photon-counting camera with use of a triple-stacked micro-channel plate

At the quantum-mechanical level, all substances (not merely electromagnetic waves such as light and X-rays) exhibit wave–particle duality. Whereas students of radiation science can easily understand the wave nature of electromagnetic waves, the particle (photon) nature may elude them. Therefore, to assist students in understanding the wave–particle duality of electromagnetic waves, we have developed a photon-counting camera that captures single photons in two-dimensional images. As an image intensifier, this camera has a triple-stacked micro-channel plate (MCP) with an amplification factor of 10⁶. The ultra-low light of a single photon entering the camera is first converted to an electron through the photoelectric effect on the photocathode. The electron is intensified by the triple-stacked MCP and then converted to a visible light distribution, which is measured by a high-sensitivity complementary metal oxide semiconductor image sensor. Because it detects individual photons, the photon-counting camera is expected to provide students with a complete understanding of the particle nature of electromagnetic waves. Moreover, it measures ultra-weak light that cannot be detected by ordinary low-sensitivity cameras. Therefore, it is suitable for experimental research on scintillator luminescence, biophoton detection, and similar topics.     

Imaging and review of a large pre-auricular pilomatrixoma in a child

A 10-year-old girl presented with a mildly tender mass in the right preauricular region. The mass became larger, and the overlying skin turned purple. There was no clinical response to a course of either cephalexin or clarithromycin. The remainder of the head and neck examination was normal including normal facial nerve function. Lyme titers and a computed tomographic (CT) scan with contrast of the facial region were obtained. The CT scan demonstrated the lesion to be superficial to the parotid gland. The lyme titer was elevated and doxycycline was begun. The mass appeared to reduce in size after doxycycline treatment, but then grew and turned erythematous. The lesion was surgically excised and was vascular with calcification and cheesy inclusions. The mass was quite close to the skin and the clinical diagnosis at the time of surgery was a pilomatrixoma, which was corroborated on pathological evaluation.