Necrotizing fasciitis caused by group A streptococcus

The first case of the confirmed necrotizing fasciitis caused by Group A Streptococcus in Yugoslavia was presented. Male patient, aged 28, in good health, suddenly developed symptoms and signs of severe infective syndrome and intensive pain in the axillary region. Parenteral antibiotic, substitutional and supportive therapy was conducted along with the radical surgical excision of the necrotizing tissue. The patient did not develop streptococcal toxic shock syndrome thanks to the early established diagnosis and timely applied aggressive treatment. He was released from the hospital as completely cured two months after the admission.     

Morphological differences among cavum septi pellucidi obtained in patients with schizophrenia and healthy individuals: forensic implications. A post-mortem study

Cavum septi pellucidi (CSP), especially when longer than 6 mm, has been recognized as a neurodevelopmental anomaly associated with schizophrenia. The present post-mortem study was designed to determine the importance of linear parameters of CSP and to evaluate the possible differences of CSP in schizophrenic patients (n=25 out of 110 CSP+ brains) and normal persons (n=40 out of 110 CSP+ brains). According to our results, schizophrenia patients had significantly longer and wider CSP than normal individuals. Also, statistical analysis revealed a higher suicide rate in CSP-positive patients with schizophrenia.     

Neuroleptic malignant syndrome and clozapine withdrawal at the same time?

The authors report a case of a patient, who in a few days after an abrupt discontinuation of clozapine and haloperidol developed agitated and confused state resembling neuroleptic malignant syndrome (NMS) and clozapine withdrawal symptoms at the same time. Data obtained from family members led to gradual reintroduction of clozapine and to subsequent recovery. The case illustrates the importance for clinicians to be familiar with the variety of discontinuation symptoms, so they can recognize them and offer effective treatment.     

Ultrasound thrombolysis

Cardiovascular diseases are a major cause of mortality in the developed world. Efficacy of thrombolysis plays an important role in the management of acute myocardial infarction and cerebral insult both in the acute event and in the long-term outcome of these patients. New adjunctive strategies have been tested, therefore, to make thrombolytic therapies more effective and safer. Ultrasound Thrombolysis is a technique which showed promising results under in vitro conditions and in animal studies. Now clinical trials have to prove if it is also feasible for clinical application. This report gives an overview on different technical approaches and their current performances in the clinical setting. All original articles are chronologically ordered in tables providing detailed information on each study concerning experimental design, acoustical parameters and thrombolysis outcome.     

Importance of oral glucose tolerance test in patient with schizophrenia

We describe the case of a 39-year-old patient with schizophrenia who developed worsening of glucose metabolism during treatment with two different atypical antipsychotics, clozapine and quetiapine. Diabetes mellitus was recognized during clozapine treatment. During quetiapine treatment, while patient was taking diabetic diet, fasting and 1-hour glucose levels and body mass index, decreased, but 2-hour glucose levels increased. This suggests that, in some patients, monitoring of only fasting glucose level and body mass index may be insufficient for detecting the glucose metabolism abnormalities. In those patients oral glucose tolerance test may be recommended. Recommendations about when and how often clinicians should administer the test do not exist in current guidelines. Further studies are needed for the elucidation of this question.     

Significance of transvaginal Doppler ultrasonography for detection of malignant gestational trophoblastic disease

Transvaginal Doppler ultrasonography has an important role in detecting and confirming the gestational trophoblastic disease (GTD). It can also be helpful in early detection of the malignant cases of GTD such as the invasion and protrusion of trophoblastic tissue into the uterine wall. Ultrasonographic picture of the malignant GTD is also specific for the presence of prominent zones of vasculavization in the peritrophoblastic tissue, as well as in the uterine tissue in which malignant GTD is developed. Resistance Index (RI) values were measured at the level of blood vessels of peritrophoblastic tissue and of suspected zones in the uterine tissue to detect neovascularization, which followed the malignant process. Theca luteal cysts were often detected by Transvaginal Doppler ultrasonography.     

Umbilical metastasis (Sister Mary Joseph's nodule) diagnosed by fine-needle aspiration

Sister Mary Joseph's nodule is the eponym for metastatic involvement of the umbilicus. This less common entity is the sign of disseminated malignant disease, mainly of digestive and gynecologic origin, and is associated with a poor prognosis. A case of Sister Mary Joseph's nodule in a 76-year-old woman in whom the umbilical metastasis was the first sign of malignant disease in presented. The diagnosis of metastatic adenocarcinoma was established by fine needle aspiration cytology of the umbilical nodule. Radiological and ultrasonographic investigation disclosed carcinoma of the gallbladder with pancreas, stomach, and colon invasion as well as peritoneal dissemination. The diagnosis was confirmed by exploratory laparatomy and histological examination of the excised umbilical nodule.     

Nocturnal microhabitat distribution of adult Culex tarsalis (Diptera: Culicidae) impacts control effectiveness

Suction traps (30 cm diameter) were more effective for non-attractant sampling of flying adult Culex tarsalis Coquillett than were smaller CDC (5.5 cm diameter), Malaise or ramp traps. Comparative catch in suction traps operated in a variety of vegetation types indicated that females congregated along elevated ecotones and were significantly less abundant flying over low vegetation or under and over elevated vegetation. Most females taken at upland orchards or Tamarisk tree lines were unfed (97%, n = 5,278) and similar in reproductive condition to host-seeking females. Blood fed and gravid females and males were only abundant near emergence sites. Pyrocide 7396 (Pyrethrin 5%, PBO 25%) was applied at the label rate of 5 oz/min by truck mounted Pro-Mist ultra low volume (ULV) equipment and particle drift measured by bioassay. ULV particles dispersed well downwind over low vegetation, between citrus orchard rows, and under date orchard canopy, but did not penetrate citrus orchards or vineyards when rows were perpendicular to wind direction. Particles did move up and over vegetation contacting sentinel mosquitoes placed above the canopy. The congregation of adult mosquitoes at vegetative ecotones and within orchard vegetation may afford protection from ground applied ULV particles, negatively impacting control. These data may explain why repeated applications often fail to interrupt encephalitis virus transmission.