Atypical magnetic resonance imaging features in subacute sclerosing panencephalitis

Objectives:Subacute sclerosing panencephalitis (SSPE) is rare chronic, progressive encephalitis that affects primarily children and young adults, caused by a persistent infection with measles virus. No cure for SSPE exists, but the condition can be managed by medication if treatment is started at an early stage.Conclusion:Early diagnosis and treatment is encouraging in SSPE, although it is not curable with current therapy. Clinico-radiological and electrophysiological correlation is very important in diagnosis of SSPE, more gravely in patients having atypical image findings as in our index case.     

'Munchausen's syndrome by proxy' or a 'miscarriage of justice'? An initial application of functional neuroimaging to the question of guilt versus innocence.

'Munchausen's syndrome by proxy' characteristically describes women alleged to have fabricated or induced illnesses in children under their care, purportedly to attract attention. Where conclusive evidence exists the condition's aetiology remains speculative, where such evidence is lacking diagnosis hinges upon denial of wrong-doing (conduct also compatible with innocence). How might investigators obtain objective evidence of guilt or innocence? Here, we examine the case of a woman convicted of poisoning a child. She served a prison sentence but continues to profess her innocence. Using a modified fMRI protocol (previously published in 2001) we scanned the subject while she affirmed her account of events and that of her accusers. We hypothesized that she would exhibit longer response times in association with greater activation of ventrolateral prefrontal and anterior cingulate cortices when endorsing those statements she believed to be false (i.e., when she 'lied'). The subject was scanned 4 times at 3 Tesla. Results revealed significantly longer response times and relatively greater activation of ventrolateral prefrontal and anterior cingulate cortices when she endorsed her accusers' version of events. Hence, while we have not 'proven' that this subject is innocent, we demonstrate that her behavioural and functional anatomical parameters behave as if she were.     

ASO Visual Abstract: No One-Size-Fits-All: Sexual Health Education Preferences in Patients with Breast Cancer

Annals of Surgical Oncology -     

Intracoronary Autologous Blood to Seal a Coronary Perforation

Background: Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. Case Report: We report on the treatment of a coronary perforation during percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending (LAD) coronary artery in a patient suffering from post infarction angina complicated by cardiogenic shock. The perforation was treated successfully with intracoronary administration of the patient's own blood. Conclusion: This new technique may be used as adjunctive therapy to prolonged balloon inflation, coronary stenting, coronary microcoil and gelfoam embolization in the treatment of severe and hemodynamically compromising perforations. Hintergrund: Die Koronarperforation ist eine seltene, aber ernsthafte Komplikation perkutaner Koronarinterventionen. Fallbeispiel: Wir berichten über die Behandlung einer während einer PTCA des Ramus interventricularis anterior (RIVA) aufgetretenen Koronarperforation. Die Indikation zur PTCA ergab sich bei Postinfarktangina und kardiogenem Schock. Die Perforation wurde erfolgreich mittels intrakoronarer Verabreichung des patienteneigenen Blutes behandelt. Schlussfolgerung: Diese neue Technik könnte als adjuvante Therapie bei prolongierter Balloninsufflation, Stentimplantation, Embolisation mittels kleiner "Coils" oder eines Gelschaumes in der Behandlung einer schweren und hämodynamisch gefährlichen Perforation diskutiert werden.     

Antiviral therapy in advanced chronic liver disease due to hepatitis C virus infection: pilot study

Background: Antiviral therapy has not been adequately evaluated in patients with hepatitis C virus (HCV)-related advanced liver disease due to apprehensions of adverse events and intolerance. The titrable dose of interferon (IFN)-alpha and ribavirin was evaluated in a flexible regimen in a pilot study. METHODS: Twenty-five patients with HCV-related advanced chronic liver disease received IFN-alpha 1-3 MIU daily with ribavirin 200-600 mg daily for 9 months-3 years. Careful assessment of safety, tolerability and efficacy was made. RESULTS: Improvement in Child-Pugh score (8.4 +/- 1.2 to 7.4 +/- 2.0; P = 0.010) and serum albumin (3.0 +/- 0.5 g/dL to 3.6 +/- 0.5 g/dL; P = 0.007) occurred at follow up after antiviral therapy (median dose and duration: IFN-alpha 1.5 MIU/day for 12 months and ribavirin 400 mg/day for 7.5 months) as compared to baseline. Ascites regressed in 53% of patients (11/21). Thirteen patients (52%) lost HCV-RNA on therapy and eight (32%) achieved sustained virological response (SVR). Death occurred in three patients (12%) while on therapy, in two due to infection. No patient died in the responder group compared to five deaths (29%) in the non-responder group. However, there was no difference in the cumulative probability of survival in the sustained virological responder versus non-responder (P = 0.09). Adverse events were common (92%), but permanent withdrawal was required in only five patients (20%). CONCLUSIONS: Low and titrable dose IFN-alpha and ribavirin therapy in patients with HCV-related advanced chronic liver disease achieves improvement in hepatic synthetic function, Child-Pugh score and ascites. However, close monitoring for serious adverse events is warranted.     

Bilateral Calcifying Odontogenic Cyst: A Rare Entity

The calcifying odontogenic cyst (COC) accounts for 1 % of jaw cysts, found most commonly as central lesion. The COC usually manifests itself as a painless, slow growing swelling, anterior to the first molar region. Radiographically it appears as a well-defined, unilocular radiolucency, and may have a radiopaque mass in its center. Majority of the cases appear before the fourth decade of life. The COC is found rarely in patients in the first decade of life. Histopathological features include a cystic lining demonstrating characteristic “Ghost” epithelial cells with a propensity to calcify. Here we report the unusual occurrence of a case of 8 year child diagnosed with bilateral COC on right and left side of mandible.     

Angioseal? as a hemostatic device for direct carotid puncture during endovascular procedures

Introduction

Direct carotid artery puncture (DCP) is employed in patients with tortuous anatomy and peripheral vascular disease when the peripheral arteries are not available for vascular access. Manual compression is the only method of achieving hemostasis following DCP and, till date, the use of a closure device for DCP has been reported in only one patient. In this study we sought to analyze our experience with the use of closure device for DCP.

Methods

This is a retrospective study of patients in whom Angioseal™ was used following DCP for neuroendovascular procedures. Medical charts and imaging of these patients was reviewed for any abnormalities pertaining to the use of the closure device.

Results

A total of eight patients were included in the study. Angioseal™ was used in all the patients. There were no complications related to the use of the closure device in any of the eight patients. Immediate post-procedure angiography done in one patient did not show any structural or hemodynamic abnormalities within the carotid artery lumen. At 6 months follow-up imaging, there was no evidence stenosis or vascular wall abnormality in any of the patients. There were no adverse clinical reactions related to the use of closure device.

Conclusion

In our experience, Angioseal™ may be a safe and off-label effective closure device for patients undergoing DCP for neuroendovascular procedures. It obviates the need for manual compression without causing any structural or hemodynamic changes within the carotid artery. Larger studies with longer follow-up are required to establish its safety in patients undergoing DCP.