Pilomatrixoma imitating infantile hemangioma

Many lesions can masquerade as infantile hemangioma, the most common tumor of infancy. We describe an infant with pilomatrixoma mimicking hemangioma. The patient presented at 8 months of age with an 1.2-cm, red, asymptomatic lesion of the right ear. The mass was noted at 4 months of age and subsequently enlarged. Ultrasonography demonstrated hypervascularity "consistent with infantile hemangioma," and the infant was observed. At 12 months of age, the lesion continued to expand and became ulcerated; it was excised, and histopathology showed pilomatrixoma. Diagnostic confusion was caused by atypical features of this pilomatrixoma that overlapped with infantile hemangioma: onset in infancy, ulceration, red color, and fast flow on imaging. Deviation from the predictable clinical features of an infantile hemangioma should prompt consideration for other types of pediatric lesions, including pilomatrixoma.     

Frequent jaw-face pain in chronic Whiplash-Associated Disorders

Chronic Whiplash-Associated Disorders (WAD) present with frequent pain in the neck, head and shoulder regions but the presence of frequent jaw-face pain is unclear. The aim of the study was to investigate the frequency of jaw-face pain, pain in other regions, and general symptoms in chronic WAD patients. Fifty whiplash-patients and 50 healthy age- and sex-matched controls were examined by questionnaire for pain in the jaw-face, pain in other regions and other symptoms. In contrast to healthy, a majority of the WAD patients (88%) reported frequent pain in the jaw-face, in addition to frequent pain in the neck (100%), shoulders (94%), head (90%) and back (72%). The WAD patients also reported stiffness and numbness in the jaw-face region, and frequent general symptoms such as balance problems, stress and sleep disturbances. The result suggests that frequent pain in the jaw-face can be part of the spectrum of symptoms in chronic WAD.The finding of self-reported numbness in the jaw-face indicates disturbed trigeminal nerve function and merits further investigation. We conclude that assessment of WAD should include pain in the jaw-face region. A multidisciplinary rehabilitation program including dentists, preferably specialized in the area of orofacial pain, should be advocated after whiplash injury.     

Cardiac involvement in congenital myotonic dystrophy.

Seven young patients (mean age 19 years 8 months) with congenital myotonic dystrophy and with defined symptoms at birth were investigated by electrocardiography and echocardiography. None had cardiovascular symptoms. Electrocardiograms or echocardiograms or both were abnormal in all patients. Atrioventricular and intraventricular conduction defects were the most common electrocardiographic abnormalities and were seen in five patients. The echocardiographic examinations showed impaired left ventricular systolic function in one patient. Other echocardiographic findings were a small left ventricle and atrium, minor valve defects, and mitral valve prolapse. This study shows that the heart is often affected in young patients with congenital myotonic dystrophy. The specialised conduction system is often affected and so too is the myocardium, causing impaired systolic function.     

Neuropsychological performance in partly remitted unipolar depressive patients: focus on executive functioning

BACKGROUND: Only few studies have investigated executive impairment in the euthymic phase of unipolar affective disorders, yielding diverging results. The role of impulsivity/orbitofrontal associated executive functioning in remitted depression has not yet been examined. METHODS: Partly remitted male out-patients (n = 15) with non-psychotic major depression (MDD) were compared with healthy males (n = 15) on several neuropsychological tests. Executive tasks focussed on orbitofrontal function (Go/No-Go, Iowa Gambling Task (IGT), delayed alternation task). Furthermore, the Barratt Impulsiveness Scale (BIS-11) was administered to all subjects. RESULTS: Executive skills of the patients were largely unimpaired. Patients exhibited significant deficits on measures of verbal memory only. Residual depressive symptoms in patients were correlated with diminished response inhibition. BIS-11 scores were not elevated in the patients. CONCLUSIONS: Both executive impairment related to orbitofrontal function and self-reported impulsive behaviour in major depression seem to be state-dependent. In accordance with other studies, patients with remitted unipolar depression showed a persistent verbal memory loss.     

How well do questionnaires on symptoms in neck-shoulder disorders capture the experiences of those who suffer from neck-shoulder disorders? A content analysis of questionnaires and interviews

Background  

Previous research has indicated neck-shoulder disorders to have a fluctuating course incorporating a variety of symptoms. These findings awoke our interest to make a comparison between symptoms experienced by people affected with the disorder and the content of questionnaires that assess pain and other symptoms in neck-shoulder disorders. Thus the aims of this study were: -to explore the symptoms experienced by people with non-specific neck-shoulder problems, as well as experiences of nuances and temporal variations (fluctuations) of symptoms; -to investigate which sources were used in the development of ten questionnaires for assessing pain and other symptoms in the neck-shoulder; -to analyse the item content of the questionnaires; -to analyse the correspondence between the item content of the questionnaires and the symptoms described by the informants.     

Restriction-mediated differential display (RMDD) identifies pip92 as a pro-apoptotic gene product induced during focal cerebral ischemia.

Studies of gene expression changes after cerebral ischemia can provide novel insight into ischemic pathophysiology. Here we describe application of restriction-mediated differential display to screening for differentially expressed genes after focal cerebral ischemia. This method combines the nonredundant generation of biotin-labeled fragment sets with the excellent resolution of direct blotting electrophoresis, reliable fragment recovery, and a novel clone selection strategy. Using the filament model in mouse with 90 minutes MCA occlusion followed by 2, 6, and 20 hours reperfusion, we have compared gene expression in sham-operated animals to both the ipsi- and contralateral forebrain hemisphere of ischemic mice. Our screening method has resulted in the identification of 70 genes differentially regulated after transient middle cerebral artery occlusion (MCAO), several of which represent unknown clones. We have identified many of the previously published regulated genes, lending high credibility to our method. Surprisingly, we detected a high degree of correspondent regulation of genes in the nonischemic hemisphere. A high percentage of genes coding for proteins in the respiratory chain was found to be up-regulated after ischemia, potentially representing a new mechanism involved in counteracting energy failure or radical generation in cerebral ischemia. One particularly interesting gene, whose upregulation by ischemia has not been described before, is pip92; this gene shows a rapid and long-lasting induction after cerebral ischemia. Here we demonstrate that pip92 induces cell death in primary neurons and displays several hallmarks of pro-apoptotic activity upon overexpression, supporting the notion that we have identified a novel pathophysiological player in cerebral ischemia. In summary, restriction-mediated differential display has proven its suitability for screening complex samples such as brain to reliably identify regulated genes, which can uncover novel pathophysiological mechanisms.     

Contact allergy to herbal teas derived from Asteraceae plants

Contact allergy to herbal teas derived from the Asteraceae plant family was investigated in patients allergic to sesquiterpene lactones (SLs). 20 patients with a known contact allergy to SLs were recalled and patch tested with aqueous extracts of 8 different herbal teas based on Asteraceae plants as well as with parthenolide and other SLs. In 18 of 20 patients with SL allergy, there were positive test reactions to the Asteraceae teas, mainly to those based on German chamomile, dandelion and wormwood. Among the SLs, parthenolide was the most frequent co-reactor. Obviously, most patients with a contact allergy to SLs are allergic to commercial teas derived from the Asteraceae plant family as well.