Hypoplasia of the cerebellar vermis and corpus callosum in thrombocytopenia with absent radius syndrome on MRI studies

Thrombocytopenia with absent radius (TAR) syndrome is infrequently (7%) associated with mental retardation. In those cases, the mental deficiency is presumed to be a consequence of intracranial hemorrhage due to the thrombo-cytopenia. We report on 2 infants with TAR syndrome. One had developmental delay with evidence of cerebral dysgenesis by magnetic resonance imaging (MRI). Such findings have not been noted in the literature, but may not have been investigated in most cases. The other infant with TAR syndrome, who has had normal psychomotor development, has a normal brain on MRI scan. Detailed neuroimaging studies, preferably MRI, should be considered in the evaluation of patients with TAR syndrome, especially when there are documented signs of developmental delay, with or without a history of intracranial hemorrhage. © 1994 Wiley-Liss, Inc.     

Floating-Harbor syndrome: description of a further patient,review of the literature,and suggestion of autosomal dominant inheritance

Abstract

The Floating-Harbor syndrome is a growth retardation syndrome with delayed bone age, speech development, and typical facial features. The face is triangular with deep-set eyes, long eyelashes, bulbous nose, wide columella, short philtrum, and thin lips. We present an additional patient and review 16 cases from the literature. The possible phenotype in the patient's mother suggests a dominant mode of inheritance for the syndrome.

Conclusion

The Floating Harbor syndrome is a growth deficiency syndrome characterized by proportionate short stature, characteristic face and delayed speech development. Inheritance is possibly autosomal dominant.     

Comparison of FDG PET and positron coincidence detection imaging using a dual-head gamma camera with 5/8-inch NaI(Tl) crystals in patients with suspected body malignancies

The purpose of this study was to compare the diagnostic accuracy of fluorine-18 fluorodeoxyglucose (FDG) images obtained with (a) a dual-head coincidence gamma camera (DHC) equipped with 5/8-inch-thick NaI(Tl) crystals and parallel slit collimators and (b) a dedicated positron emission tomograph (PET) in a series of 28 patients with known or suspected malignancies. Twenty-eight patients with known or suspected malignancies underwent whole-body FDG PET imaging (Siemens, ECAT 933) after injection of approximately 10 mCi of 18F-FDG. FDG DHC images were then acquired for 30 min over the regions of interest using a dual-head gamma camera (VariCam, Elscint). The images were reconstructed in the normal mode, using photopeak/photopeak, photopeak/Compton, and Compton/photopeak coincidence events. FDG PET imaging found 45 lesions ranging in size from 1 cm to 7 cm in 28 patients. FDG DHC imaging detected 35/45 (78%) of these lesions. Among the ten lesions not seen with FDG DHC imaging, eight were less than 1.5 cm in size, and two were located centrally within the abdomen suffering from marked attenuation effects. The lesions were classified into three categories: thorax (n=24), liver (n=12), and extrahepatic abdominal (n=9). FDG DHC imaging identified 100% of lesions above 1.5 cm in the thorax group and 78% of those below 1.5 cm, for an overall total of 83%. FDG DHC imaging identified 100% of lesions above 1.5 cm, in the liver and 43% of lesions below 1.5 cm, for an overall total of 67%. FDG DHC imaging identified 78% of lesions above 1.5 cm in the extrahepatic abdominal group. There were no lesions below 1.5 cm in this group. FDG coincidence imaging using a dual-head gamma camera detected 90% of lesions greater than 1.5 cm. These data suggest that DHC imaging can be used clinically in well-defined diagnostic situations to differentiate benign from malignant lesions.     

An organizational model of sports medicine facilities in the United States

Information on establishing the organizational structure of sports medicine clinics is useful to clinicians intending to start or expand a clinic. The purpose of this study was to identify an organizational model of existing sports medicine facilities in terms of: 1) administration and management, 2) staff qualifications and professional development, 3) location of facility, 4) range of services, 5) availability of services, 6) physician referral base, and 7) fee structure. A survey of 250 sports medicine clinics located in or near urban cities across the United States was conducted by mail. Results of this study indicate that the typical sports medicine facility is corporate-owned. A physical therapist and/or a physician establishes policy, and the physical therapist directs day-to-day operations. On average, the professional staff have four years of athletic team affiliation and seven years of clinical experience with athletes. The staff have attended less than an average of one continuing education course a year over the last five years. The typical facility is located within five miles of a major city, within 10 miles of its primary referral source and competition, and within 10 miles of its clients' homes. Most facilities employ combinations of full-time and part-time physicians, physical therapists, and athletic trainers. The typical sports medicine facility is open 12 hours each weekday. The physician referral base is composed primarily of orthopaedic and family practice physicians who refer an average of 14 new patients a week. J Orthop Sports Phys Ther 1992;15(2):80-86.     

Adolescent depressive disorder: a population-based study of ICD-10 symptoms

OBJECTIVE: Earlier studies have suggested that symptoms of depressive disorder in adolescents may differ from those found in adults. Even so, diagnostic criteria developed in adults have come to be widely applied to younger subjects. This study examines the frequency of ICD-10 symptoms in depressive disorder and their association with severity in a large community sample of adolescents aged 15 to 18 years. METHOD: A six-wave prospective study of adolescent health and emotional wellbeing in 2032 Australian secondary school students provided an opportunity to conduct a two-phase study of adolescent onset depression. A self-administered computerised form of the revised Clinical Interview Schedule (CIS-R) was used as a first phase diagnostic measure. Second phase assessment using the Composite International Diagnostic Interview (CIDI) allowed the delineation of a group fulfilling criteria on both instruments. The ICD-10 symptoms and severity profiles for depression were generated with standard algorithms. RESULTS: 1947 (95.8%) out of 2032 subjects in the designated sample completed phase 1 assessment at least once. Participation rates at phase 2 interviews were 93%. Over the 30-month study period 69 subjects (10 male, 59 female) fulfilled criteria for ICD-10 depressive episodes on both the CIS-R and CIDI. Thirty-one per cent (n = 21) had experienced a severe episode, 46% (n = 32) moderate and 23% (n = 16) mild episodes. Loss of interest and pleasure, decreased energy and fatigue, sleep disturbance, suicidal ideation and diminished concentration most clearly distinguished adolescents with depressive disorder from controls. Self-reproach and guilt, psychomotor agitation and/or retardation and appetite disturbance with weight change showed the clearest increase in frequency with increasing severity of episode. The somatic syndrome was reported by close to one in three of those with a severe depressive episode, but was uncommon in those with mild and moderate episodes. CONCLUSIONS: The ICD-10 diagnostic criteria are applicable to depressive disorder in older adolescents. With the exception of depressed mood, found in one in five non-cases, all other symptoms were common in cases and uncommon in non-cases. Practitioner awareness of symptoms indicating the presence and severity of disorder should enhance early identification and choice of treatment in adolescent depression.     

Successful treatment with lamivudine for fulminant reactivated hepatitis B infection following intensive therapy for high-grade non-Hodgkin's lymphoma

Chronic carriers of Hepatitis B virus (HBV) infection, who are treated for malignant lymphoma, are at high risk of mortality from reactivated HBV infection. We report a case of a 29-year-old male chronic HBV carrier who developed fulminant reactivated HBV infection following intensive chemotherapy for stage IV^B large cell B-cell non-Hodgkin's lymphoma associated with extensive central nervous system and bone marrow involvement. Prior to chemotherapy the patient had normal liver function tests and was negative for HBV DNA by semi-quantitative PCR assay. Fulminant HBV reactivation was confirmed following clinical deterioration, massive rises in hepatic transaminases (peak alanine aminotransferase = 2,850 U/l), liver biopsy and rising levels of serum HBV DNA. Following treatment with lamivudine 150 mg bd for 18 weeks dramatic and sustained recovery ensued. Symptoms and liver function tests improved within days and HBV DNA became negative within 12 weeks. Our patient later died from relapsed lymphoma but without evidence of reactivated HBV infection. We advise that lamivudine should be considered during intensive chemotherapy treatment of chronic carriers of HBV.     

HIV AND TUBERCULOSIS CO-INFECTION IN A REFERRAL CHEST HOSPITAL

Serving personnel of Armed Forces admitted with tuberculosis between Apr 1996–1999 were evaluated for co-infection of tuberculosis and HIV. Sixty (1.06%) of tuberculosis patients were found to be HIV positive. Initial test was done by spot kits and subsequently confirmed by ELISA on two different samples. Majority of the cases were in sexually active age group 48 (80%). Alcohol and smoking was associated in 80% cases. Thirty six (60%) were sputum smear positive for AFB. Twenty eight (46.7%) gave history of exposure to sex workers. Family members were not available for study. Sero prevalence of HIV in association with tuberculosis is less in Armed Forces compared to civil population.KEY WORDS: HIV, Seroprevalence, Tuberculosis     

Periarticular heterotopic ossification after multiple knee ligament reconstructions. A report of three cases

Heterotopic ossification is a frequently encountered clinical and radiographic entity. There are no previous reports in the English literature of heterotopic ossification after arthroscopically assisted ligament reconstructions for knee dislocations. Further, a link between the PCL reconstruction and posterior capsular ossification has not been heretofore recognized. Our three cases should raise the clinical awareness of such an entity.