Subcutaneous zygomycosis: report of 10 cases from two institutions in North India

Background Subcutaneous zygomycosis is an uncommon condition observed in tropics. Few series have been published, particularly from the northern regions of India. Objectives The aim of this study was to describe clinical, investigative and therapeutic details in subcutaneous zygomycosis observed in two teaching hospitals in Delhi. Patients and methods Ten patients seen over a period of 10 years (1999–2009) form the material for this report. Results There were four children and six adults. In four children, the presentation was a subcutaneous localized mass or gradually spreading plaque. In the others, it was observed over nasal region of face, spreading inward into mucosal sites and paranasal sinuses, and outward to the contiguous areas. Regional lymphadenopathy was present in two with facial lesions. Majority showed a granulomatous infiltrate with admixture of other cells, mainly eosinophils. Aseptate or poorly septate hyphae were observed in seven. In one patient in whom no hyphae were observed, there was dense perivascular inflammation. Organisms were cultured from four patients, Basidiobolus ranarum in two and Syncephalastrum racemosum in two. The main therapy used was a saturated solution of potassium iodide (KI). Four received only KI of which two attained cure after 3 months and 9 months respectively, and the other two showed signs of regression. In one boy subsidence was associated with reduced circumference of thigh. Ketoconazole or itraconazole was given with KI to hasten regression when response was slow or there were side‐effects to KI. Conclusion Awareness and early recognition will prevent disfigurement produced by advanced disease, misdiagnosis and unnecessary surgical intervention.     

Patients' attitudes to totally implantable venous access port systems for gynecological or breast malignancies.

AIMS: The aim of this study was to analyze patients' port-related quality of life. PATIENTS AND METHODS: 260 consecutive patients with gynecological or breast malignancies were asked to take part in a questionnaire-based survey including 26 questions, and 232 women agreed to participate in the study. The questionnaire inquired about port-related aspects of everyday life and the use of a central venous access port device for chemotherapy and supportive cancer care. Multivariate analysis was used to identify parameters associated with satisfaction and dissatisfaction in relation to the port. RESULTS: Most of the women were very satisfied with the use of a port to provide venous access for chemotherapy and supportive cancer care. Faster hospital procedures, good cosmetic results, and the ability to cope with the social environment had a significant influence on the degree of satisfaction. Fear of port punctures, inconvenient heparinization of the port, and fear of complications were found to be negative variables associated with the method. CONCLUSIONS: Port catheters are well accepted by patients for chemotherapy and supportive cancer care. Generally ports should be rapidly removed after the end of antineoplastic treatment in order to improve patients' satisfaction with the procedure.     

A new view of things

Ohne Zusammenfassung     

The role of scintigraphy in the diagnosis of mandibular bone changes

Investigating the scintigraphic images of jaws may have a diagnostic value of bone alterations of dental origin. Anterior view of whole body bone scintigraphy revealed hot spot on jaws of 61% (279) of patients. Twenty-six patients (mean age 58.3 year) from all of those who had increased tracer uptake (ITU) in the maxillo-mandibular region were called back for dental examination. 279 out of 459 (61%) patients had ITU in the maxillo-mandibular region. Dental examination revealed the dental origin of ITU in all cases. In case of periapical pathosis tracer uptake showed 28.79% increase compared to the contralateral side. In marginal periodontitis 23.82% ITU was found. In case of loading due to prosthesis 13.06% ITU was observed. The mean DMF-T value was 26.36 +/- 4.52 (D = 4.12, M = 20.8, F = 1.44). The prosthetic index was 0.42 on the mandible. The above mentioned data mean very low oral health conditions of the patients included in this examination. The results show that bone scintigraphy is a valuable procedure in detecting tooth related jaw lesions. Bone scintigraphy provides very useful data on oral health of these patients. Enrolling of these patients into regular dental care is inevitable.     

Cerebellum and speech perception: a functional magnetic resonance imaging study

A variety of data indicate that the cerebellum participates in perceptual tasks requiring the precise representation of temporal information. Access to the word form of a lexical item requires, among other functions, the processing of durational parameters of verbal utterances. Therefore, cerebellar dysfunctions must be expected to impair word recognition. In order to specify the topography of the assumed cerebellar speech perception mechanism, a functional magnetic resonance imaging study was performed using the German lexical items "Boden" ([bodn], Engl. "floor") and "Boten" ([botn], "messengers") as test materials. The contrast in sound structure of these two lexical items can be signaled either by the length of the wordmedial pause (closure time, CLT; an exclusively temporal measure) or by the aspiration noise of wordmedial "d" or "t" (voice onset time, VOT; an intrasegmental cue). A previous study found bilateral cerebellar disorders to compromise word recognition based on CLT whereas the encoding of VOT remained unimpaired. In the present study, two series of "Boden - Boten" utterances were resynthesized, systematically varying either in CLT or VOT. Subjects had to identify both words "Boden" and "Boten" by analysis of either the durational parameter CLT or the VOT aspiration segment. In a subtraction design, CLT categorization as compared to VOT identification (CLT - VOT) yielded a significant hemodynamic response of the right cerebellar hemisphere (neocerebellum Crus I) and the frontal lobe (anterior to Broca's area). The reversed contrast ( VOT - CLT) resulted in a single activation cluster located at the level of the supratemporal plane of the dominant hemisphere. These findings provide first evidence for a distinct contribution of the right cerebellar hemisphere to speech perception in terms of encoding of durational parameters of verbal utterances. Verbal working memory tasks, lexical response selection, and auditory imagery of word strings have been reported to elicit activation clusters of a similar location. Conceivably, representation of the temporal structure of speech sound sequences represents the common denominator of cerebellar participation in cognitive tasks acting on a phonetic code.     

Prognostic relevance of MAGE-A4 tumor antigen expression in transitional cell carcinoma of the urinary bladder: a tissue microarray study

TAAs of the MAGE family are mostly studied as targets of specific immune responses. Their potential relevance as tumor markers has also been underlined. We used a MAb, 57B, recognizing MAGE-A4 protein in paraffin-embedded sections, to evaluate its expression in bladder cancers by employing TMA including 2,317 samples from 1,849 patients. In 2,090/2,317 cases (90.2%), immunostaining yielded interpretable results. Since for some patients more than 1 sample was available, only interpretable first biopsies (n = 1,628) were considered. MAGE-A4 protein was expressed at significantly (p < 0.001) higher frequency in squamous (25/55, 45.5%) than in adeno (4/15, 26.7%), sarcomatoid (4/14, 28.6%), small cell (5/20, 25%) or transitional cell (281/1,522, 18.5%) carcinomas. In TCCs, overall MAGE-A4 positivity was significantly correlated with invasive phenotype (p < 0.001) and high tumor grade (p < 0.0001). Clinical data from 908 TCC patients were retrospectively evaluated, revealing that strong 57B staining was highly significantly associated with decreased tumor-specific survival (p < 0.0001). These data suggest that evaluation of MAGE-A4 protein expression is useful in the identification of groups of TCCs characterized by severe prognosis, thus possibly providing indications for early MAGE TAA-targeted immunotherapy.     

Heart-rate-adapted image reconstruction in multidetector-row cardiac CT: influence of physiological and technical prerequisite on image quality

The purpose of this study was to develop strategies for optimal image reconstruction in multidetector-row cardiac CT and to discuss the results in the context of individual heart rate, cardiac physiology, and technical prerequisite. Sixty-four patients underwent multidetector-row cardiac CT. Depending on the heart rate either a single-segmental reconstruction (SSR) or an adaptive two-segmental reconstruction (ASR) was applied. Image reconstruction was done either antegrade (a) or retrograde (r) in relation to the R-peak. Reconstruction of all data sets was performed at multiple time points within the t-wave/p-wave interval, differing from each other by 50 ms. In addition, each reconstruction was assigned to one of six reconstruction intervals (A–F), each corresponding to a specific event in the cardiac cycle. While no significant time points were found for absolute values, the following interval/reconstruction technique combinations provided significant better image quality: F/r at HR <60 bpm for all coronary segments (p≤0.004) and at HR 60–65 bpm for segments 5–10 (p≤0.001); B/a at HR 60–65 bpm for segments 1–4 and 11–15 (p<0.001) and at HR >65 bpm for all segments (p≤0.002). The results show that in order to achieve optimal image quality, image reconstruction has to be adjusted to each patient's ECG curve and heart rate individually. The moment of reconstruction should be determined as absolute rather than as relative distance from the previous R-peak. Electronic Publication     

Practice MRI: Reducing the need for sedation and general anaesthesia in children undergoing MRI

The aim of this study was to evaluate the effectiveness of a practice magnetic resonance unit, in preparing children to undergo magnetic resonance procedures without general anaesthesia (GA) or sedation. The records of children who attended the practice MRI between February 2002 and April 2004 were retrospectively reviewed. Each record was assessed as to whether the child had passed or failed the practice MRI intervention. Those children who were considered to have passed and were proceeded to a clinical non‐GA MRI had the report of the clinical scan reviewed. If the scan had been reported as non‐diagnostic because of movement artefact it was classified as a failed scan, otherwise it was considered a pass. One hundred and thirty‐four children undertook a practice MRI (age range 4.1–16.1 years, median age 7.7 years, 47% boys) and 120/134 (90%) passed the practice session. In all, 117/120 (98%) subsequently had a clinical non‐GA MRI and 110/117 (94%) passed (median age 7.8 years, 47% boys). Preparation is a safe and effective method to reduce the need for sedation and GA in children undergoing a clinical MRI scan. It provides a positive medical experience for children, parents and staff, and results in cost savings for the hospital.