Xanthoma disseminatum: a child with respiratory system involvement and bronchiectasis

Xanthoma disseminatum (XD) is a rare normolipemic mucocutaneous xanthomatosis due to the proliferation of non-x histiocytes. Occasional involvement of the upper respiratory system has been reported, but lower respiratory tract involvement is very rare. Here, we present a child with severe involvement of the upper and lower respiratory tract by XD and bronchiectasis in the lower lobes of both lungs. The patient was an 8-year-old boy who was admitted to our hospital because of red-brown papules which developed on the skin and progressive dyspnea. He was diagnosed as having XD by skin biopsy. Physical examination revealed disseminated, numerous yellow-reddish brown papular xanthomas on the forehead and eyelids, around the neck and axillary area, and in the oral cavity and pharynx. He had respiratory distress and clubbing of the fingers. Chest x-rays showed hyperaeration and segmental atelectasis. High-resolution CT of the thorax revealed diffuse thickening of the whole tracheal and bronchial wall, and bronchiectasis in the lower lobes. Flexible fiberoptic bronchoscopy revealed numerous xanthomatous lesions in the nasal cavity, nasopharynx, oropharynx, subglottic area, trachea, bifurcation, both main bronchi, and smaller bronchi. To the best of our knowledge, this is the first report of a child with typical lesions of XD with severe involvement of the lower respiratory tract and bronchiectasis.     

The evaluation of MTA and Biodentine as a pulpotomy materials for carious exposures in primary teeth

Clinical Oral Investigations - This study examined the effects of MTA and Biodentine on the clinical and radiographic success rates of pulpotomies performed on primary teeth with carious pulp...     

Negative serology: could exclude the diagnosis of brucellosis?

Two cases of brucellar spondylodiscitis of the lumbar area were presented. Although both cases showed typical radiological changes, serological tests could not detect Brucella agglutinating antibodies. One of the patients was bacteremic and Brucella spp. was identified from blood culture. In the second patient needle biopsy was required for definite diagnosis. Although small, serologic tests have a certain rate of false negative results in brucellosis. Thus, a negative serology should not exclude the diagnosis of brucellosis, as it is demonstrated in the current cases.     

Cervical vestibular evoked myogenic potentials in primary headache disorders

ObjectiveTo determine if cervical vestibular evoked myogenic potentials (cVEMPS) differ in patients with migraine without aura (MoA), vestibular migraine (VM) and tension type headache (TTH).MethodsTwenty patients with MoA, 24 patients with VM and 20 patients with TTH were included in the study. Thirty healthy volunteers of comparable age and gender were taken as the control group. The latencies of peaks p13 and n23, peak-to-peak amplitude of p13–n23 divided by a mean prestimulus EMG recorded during cVEMP testing were measured. The amplitude asymmetry between right and left sides was also calculated and taken into consideration. Caloric testing was conducted to check if the results are associated with the results of the cVEMPs.ResultsFive (one on the right, four on the left side) of the 24 patients with VM (20.8%) displayed a unilateral caloric hypofunction. Normal results were recorded from patients with MoA and TTH. p13, n23 latencies and amplitudes of the patient groups were not statistically different from the results of the healthy controls (p > 0.05). An amplitude asymmetry between right and left sides exceeding that of the healthy controls was not also present (p > 0.05).ConclusionsThough a hypofunctioning horizontal semicircular canal was detected in 20.8% of the patients with VM, saccular function seemed to be unaffected. Patients with MoA and TTH did not display any vestibular test abnormality.SignificancePrimary headache disorders seem to be associated with a normal interictal cVEMP profile.     

Falcine venous plexus within the falx cerebri: anatomical and scanning electron microscopic findings and clinical significance

Background

Only limited attention has been paid to the anatomy and clinical importance of the falcine venous plexus. The aim of this study was to evaluate the falcine venous plexus anatomically using scanning electron microscopy (SEM), and to provide guidance for neurosurgical approaches.

Methods

Latex or ink was injected into the superior and inferior sagittal sinus. The falcine venous plexus lying within the connective tissue of the falx cerebri was observed by dividing the falx into thirds (anterior, middle and posterior). Further, the SEM appearance of the falcine venous plexus was evaluated.

Results

The anterior third of the falx cerebri consisted of small diameter falcine venous vessels. These vessels were localized close to either the superior or inferior sagittal sinus, and none extended as far as mid-falx cerebri levels in any of the 16 cases. They communicated with either superior or inferior sagittal sinuses, but not with both of these sinuses. In the middle third of the falx cerebri, the majority of the vessels of the falcine venous plexus had larger diameter compared to those of the anterior third. These vessels extended the length of the falx cerebri levels. They communicated with both superior and inferior sagittal sinuses. In the posterior third of the falx cerebri, the vessels of the falcine venous plexuses had the largest diameter and were located at the junction of the inferior sagittal sinus and the straight sinus. They were localized at the lower two-thirds of the falx cerebri. In all cases, the dense venous networks communicated with the inferior sagittal sinus but not with the superior sagittal sinus. The falcine venous plexus observed in the posterior third of the falx cerebri was denser than in the anterior and middle portions. The SEM revealed small vessels whose diameter ranged between 42 and 138 μm. The vessels of the falcine venous plexus in the anterior third had a mean diameter of 0.42?±?0.1 mm, in the middle third a mean diameter of 0.87?±?0.17 mm, and in the posterior third, 1.38?±?0.21 mm.

Conclusion

The falcine venous plexus is a network of venous channels that exists within the connective tissue of the falx; the sizes and patterns of communication of these structures showed regional differences. Neurosurgeons should be aware of the regional differences when making an incision or puncturing the falx during a surgical approach.