Intracerebral arteriovenous malformations: evaluation with selective MR angiography and venography

Magnetic resonance (MR) angiography and spin-echo methods were used to evaluate intracerebral arteriovenous malformations (AVMs) in 10 patients. Spin-echo images obtained with flow presaturation demonstrated the nidus of the AVM in all cases, but it was difficult to determine feeding vessels. These vessels were directly visualized with three-dimensional MR angiography; their presence could be indirectly determined by means of selective presaturation of individual vessels, which resulted in a marked decrease in signal within the portion of the AVM supplied by that vessel. Vascular supplies from the internal carotid artery and anterior, middle, or posterior cerebral arteries were detected in all cases, but in three large malformations it was not possible to demonstrate small feeding vessels. MR angiograms were also helpful for further defining the nidus. The combination of MR angiographic and spin-echo methods provides information useful for therapeutic planning not provided by either technique alone.     

Extra-adrenal nonfunctional retroperitoneal paraganglioma: case report and review of the literature

An extra-adrenal paraganglioma is a rare tumor derived from the chromaffin cells of sympathetic ganglia. This report documents a rare case of nonfunctional extra-adrenal paraganglioma in a 20-year-old woman with persistent flank pain. Ultrasonography and computed tomography revealed a solid mass with calcification in center, measuring 7 x 6 x 6 cm, and localized in the left upper para-aortal retroperitoneal region. Absence of typical clinical symptoms made a correct preoperative diagnosis unlikely. Tumor was successfully removed through a midline laparotomy incision, and pathological analysis of the surgical specimen revealed a paraganglioma. After 12 months, the patient is still in a good health, asymptomatic, and without evidence of tumor recurrence. This case emphasizes the necessity to include extra-adrenal paraganglioma in the differential diagnosis and management of retroperitoneal tumors, despite its rarity.     

Evaluation of methyl inosine monophosphate (MIMP) and peramivir activities in a murine model of lethal influenza A virus infection

An inbred murine model (BALB/c) was utilized to assess the protective effect of the immunomodulator methyl inosine 5'-monophosphate (MIMP) against infection with influenza A/PR/8/34 (H1N1) virus. Contrary to the data reported for outbred mice (NMRI) infected with the aerosolized virus (Masihi, Hadden, 2003. J. Int. Immunopharmacol. 3, 1205-1215), there were no improvements in the outcomes of infection in the inbred animals treated with MIMP intranasally 1 day before the challenge and/or orally after the challenge for 5 days (up to 10 mg/kg/day). Nevertheless, complete protection against lethality was afforded by the treatment with the neuraminidase inhibitor peramivir given once daily for 5 days after the challenge (10 mg/kg/day). We speculate that the rapid progression of the disease in inbred mice caused by the intranasal challenge may render the MIMP-treatment ineffective. Our results emphasize the need for careful consideration of murine strains and routes of virus challenge in the design of experiments utilizing lethal influenza virus infection.     

Induction of cytochrome P-450 isozymes during long-term nifedipine administration

Department of Cell Physiology and Pathology, Institute of Clinical and Experimental Medicine, Siberian Branch, Academy of Medical Sciences of the USSR, Novosibirsk. Department of Drug Toxicology, Institute of Physiology, Bulgarian Academy of Sciences, Sofia. (Presented by Academician of the Academy of Medical Sciences of the USSR V. P. Kaznacheev.) Translated from Byulleten' Éksperimental'noi Biologi i Meditsiny, Vol. 109, No. 2, pp. 148–150, February, 1990.     

An attenuated West Nile prototype virus is highly immunogenic and protects against the deadly NY99 strain: a candidate for live WN vaccine development

In a short time, West Nile virus has developed into a nationwide health and veterinary problem. The high virulence of the circulating virus and related lineage 1 WN strains hinders development of an attenuated live vaccine. We describe an attenuated WN isolate, WN1415, which is a molecularly cloned descendant of the WN prototype B956 strain. The parent virus belongs to lineage 2, members of which have not been associated with epidemic or epizootic outbreaks. A set of non-conservative mutations, mostly in non-structural protein genes, distinguishes the WN1415 isolate from the parent B956 prototype strain. Immunization with WN1415 (55-550,000 pfu) established a potent immunity, which protected the majority of mice against lethal challenge with WN NY99. The attenuated nature of the isolate and its excellent growth characteristics combined with the availability of a highly stable infectious clone make the isolate an attractive candidate for live WN vaccine development.     

Cluster of Oseltamivir-Resistant and Hemagglutinin Antigenically Drifted Influenza A(H1N1)pdm09 Viruses,Texas, USA,January 2020

Four cases of oseltamivir-resistant influenza A(H1N1)pdm09 virus infection were detected among inhabitants of a border detention center in Texas, USA. Hemagglutinin of these viruses belongs to 6B.1A5A-156K subclade, which may enable viral escape from preexisting immunity. Our finding highlights the necessity to monitor both drug resistance and antigenic drift of circulating viruses.     

Appendiceal Mucinous Cystadenocarcinoma with Implantation Metastasis to the Incision Scar and Cutaneous Fistula

Introduction  

Mucinous cystadenocarcinoma of the appendix with invasion of the anterior abdominal wall and cutaneous fistula development is a rare condition. To the best of the authors’ knowledge, five such cases have been reported in the medical literature.     

Recurrent recurrent gallstone ileus

We describe the second reported case of three consecutive episodes of gallstone ileus and ask the question whether recurrent gallstone ileus justifies definitive surgery to the fistula itself or can be safely managed by repeated enterotomies.     

‘Working together’ - A new approach to Reviewing the Quality of Postgraduate Medical Training Posts in Northern Ireland?

Many of us are involved in the education and training of junior doctors. Maintaining and improving the quality of such training is the common goal of all medical educators, including those working in the Northern Ireland Medical and Dental Training Agency (NIMDTA) and within our hospitals – the Local Education Providers (LEPs). The development of NIMDTA’s Placement Quality Initiative (PQI) aims to create a more collaborative working relationship between NIMDTA and the LEPs, working together, to achieve a shared goal and develop and implement strategies to improve current practice. We review the PQI process, from both a trainee and trainer’s perspective, and ascertain if this approach has facilitated positive, reproducible changes in training programmes that are felt at ground level.