Spinal subdural tuberculous abscess

OBJECTIVES: Spinal subdural abscess is rare and only 48 cases have been described to date. In this report, we present an additional spinal subdural tuberculous abscess. METHOD: Tuberculous meningitis was diagnosed with clinical and laboratory findings in a 45-year-old man. A spinal subdural abscess was demonstrated using MRI. Presence of the abscess was revealed by surgical intervention. The diagnosis was confirmed by pathological examination. RESULTS: The patient had been treated for tuberculous meningitis 2 years previously. The disease recurred when anti-tuberculous therapy was prematurely discontinued. During the second treatment, the patient also underwent a ventriculo-peritoneal shunt operation for hydrocephalus. Dizziness and weakness of both legs developed after the postoperative period. Spinal MRI showed a spinal subdural abscess as a iso-intense mass with spinal cord in the T1 and T2 weighted images, ring like enhancement and compression on the spinal cord at T3-T4 level. The patient underwent surgery and the abscess was drained. CONCLUSION: Tuberculosis may cause a spinal subdural abscess and although it is a rare disorder, when encountered MRI is very useful in the diagnosis.     

Cancer of the respiratory organs with respect to environmental and life style factors in the areas of Split, Solina and Kastela] Citation

This investigation focused on Split and the industrial area of the Solin-Kastela bay, as it has been known for cement production for over 130 years, and for asbestos cement production for some 80 years. Environmental factors (air pollution) and lifestyle (cigarette smoking and alcohol consumption) were investigated in persons who died of cancer of respiratory organs. The aim was to see what is the combined effect of several noxious factors and how it may increase the risk of cancer of the respiratory organs. The sample of 473 subjects was randomly selected from 1490 persons who died of cancer of respiratory organs in the studied area between 1970 and 1990. The data on the subjects' lifespan, smoking habit, and alcohol consumption were obtained by interviewing their families. Environmental data showed that 5% had lived in an area with industrial air pollution (cement, asbestos-cement) for up to 15 years, 19% from 16 to 29 years, 33% from 30 to 49 years, and 44% for 50 years and over. The number of those exposed to air pollution for 50 years and over ranged from 36% to 68% in different districts. Of 473 subjects 85% had been cigarette smokers; 42% had smoked over 40 cigarettes a day, 83% had smoked for over 30 years, and 74% of subjects had consumed alcohol. The largest number of persons in the studied group were in the category with the longest exposure to air pollution and the longest and most intensive smoking experience. This indicates the possibility that simultaneous action of environmental factors and lifestyle may increase the risk for the development of cancer of respiratory organs. Smokers showed a significant shift (in percentage) towards shorter length of living in the studied area. That suggests that the risk of cancer of respiratory organs was greater in cigarette smokers than nonsmokers, regardless of the fact that both were exposed to comparable air pollution.     

Cyst fluid tumor-associated trypsin inhibitor may be helpful in the differentiation of cystic pancreatic lesions

In clinical practice it is important to differentiate pseudocysts from cystic pancreatic tumors, especially potentially malignant mucinous cystic tumors. We investigated three new markers—tumor-associated trypsin inhibitor (TATI) and the free α and β subunits of human choriogonadotropin (hCGα and hCGβ, respectively)—in the cyst.uid of patients with cystic pancreatic lesions and compared the concentrations of these markers to those of carcinoembryonic antigen (CEA), CA 19-9, CA 242, CA 125, CA 15-3, alpha-fetoprotein, and tissue polypeptide antigen in order to distinguish benign cysts from malignant cysts. Between 1995 and 2001, a total of 34 patients operated on for cystic pancreatic lesions at Tampere University Hospital were included. Cyst fluid was aspirated at operation and stored at_70 C. Thehistologic diagnosis was pseudocyst in 23 patients, serous cystadenoma (SCA) in four patients, benign mucinous cystadenoma (MCA) in four patients, cystic papillary neoplasm (CPN) in one patient, glucagonoma in one patient, and malignant endocrine islet cell carcinoma (EC) in one patient. Significantly higher concentrations of TATI were found in patients with MCA and EC (2239 ± 149 μg/L [mean ± SEM]) than in patients with pseudocyst (55 ± 29 μg/L; P = 0.001) and in patients with SCA (36 ± 23 μg/L; P = 0.01). The patient with CPN and the patient with glucagonoma had relatively low levels of TATI (30.7 and 46.5 μg/L). Mean CEA was higher in patients with MCA compared to those with pseudocysts (19,993 ± 9418 vs. 53 ± 20 μg/L, P = 0.002) and SCA (0.4 ± 0.1 μg/L; P = 0.02), but in the patient with malignant EC, the patient with CPN, and the patient with glucagonoma, CEA was normal. HCGα, hCGβ, CA 19-9, CA 242, CA 125, CA 15-3, alpha fetoprotein, and tissue polypeptide antigen could not distinguish between MCA vs. pseudocyst or SCA, because both normal and elevated values were seen in all groups. To our knowledge, this is the first time that TATI has been quantitated in the cyst fluid of patients with cystic pancreatic lesions. It appears to be a potential marker in the differential diagnosis of benign from malignant cystic pancreatic lesions. Supported by the Medical Research Fund of Tampere University Hospital.     

Occupational exposure to manganese.

The relationship between the degree of exposure and biological effects of manganese was studied in a group of 369 workers employed in the production of ferroalloys. Two other groups of workers, from an electrode plant and from an aluminium rolling mill, served as controls. Mean manganese concentrations at work places where ferroalloys were produced varied from 0-301 to 20-442 mg/m3. The exposure level of the two control groups was from 2 to 30 microgram/m3 and from 0-05 to 0-07 microgram/m3, in the electrode plant and rolling mill respectively. Sixty-two (16-8%) manganese alloy workers showed some signs of neurological impairment. These signs were noticeably less in the two control groups (5-8% and 0%) than in the occupationally exposed group. Subjective symptoms, which are nonspecific but may be symptoms of subclinical manganism, were not markedly different in the three groups. However, in the manganese alloy workers some of the subjective symptoms occurred more frequently in heavier smokers than in light smokers or nonsmokers. Heavier smokers engaged in manganese alloy production showed some of the subjective symptoms more often than heavier smokers from the control groups.     

Hemodynamic Effects of Propanidid in Man

An 12 Versuchspersonen, die entsprechend ihrem Alter in zwei Gruppen von je 6 unterteilt waren, wurden die hämodynamischen Auswirkungen von 10 mg/kg Propanidid, äber 60 Sekunden i. v. ver-abreicht, studiert. Das Durchschnittsalter der beiden Gruppen war 22 bzw. 69 Jahre. Obwohl sich quantitative Unterschiede in der Propanididwirkung zwischen den beiden Gruppen ergaben, konnte doch dem Altersfaktor allein kein bedeutender modifizierender Einfluß auf die Wirkungen des Propanidids zugeschrieben werden. Es wird der Schluß gezogen, daß Propanidid in beiden eine arterielle Blutdrucksenkung hervorruft, vorwiegend als Folge eines verminderten peripheren Gefäßwiderstandes, vergesellschaftet mit einer Abnahme des Schlagindex, die durch eine Herzfrequenzsteigerung kompensiert wird. In beiden Gruppen normalisierte sich der Blutdruck nach 5 Minuten zufolge einer Zunahme des peripheren Gefäßwiderstandes.