Diagnosis and treatment of orbit posttraumatic subperiosteal hemorrhage in a child, associated with a subdural intracranial hemorrhage

We describe a rare case of traumatic subperiosteal orbital hematoma in a child, with intracranial hemorrhagic complication. Subperiosteal hematoma are the more infrequent occurrences among intraorbital hemorrhagic lesions and can be also associated with intracranial extradural hematoma in patients with orbital roof fracture. Here, we describe a case without roof fracture but with a never-before described intracranial subdural hematoma. The patient underwent computed tomography and magnetic resonance imaging, in an acute state, and later, a radiologic diagnosis of percutaneous drainage of the hematoma was mad. MRI was more sensitive and specific in the evaluation of the intracranial and intraorbital complication.     

Diffuse peritoneal metastases from primary colon cancer demonstrated by Tc-99m-labeled red blood cell scintigraphy

An 80-year-old man, who underwent complex abdominal surgery for left colon cancer 2 years earlier, was hospitalized because of severe anemia and recurrent episodes of melena. Esophagogastroduodenoscopy and colonoscopy did not reveal abnormal findings. Abdominal ultrasonographic examination and computed tomographic scan failed to detect tumor recurrence or metastatic lesions but moderate ascites was found. Tumoral marker serum levels were abnormal. Tc-99m red blood cell scintigraphy was performed and disclosed a potential site of intestinal hemorrhage: both dynamic and static images showed a slight but diffuse and persistent uptake of Tc-99m erythrocytes in the entire abdomen with no clear evidence of a site of active bleeding. These findings suggested diffuse peritoneal micrometastases, which were confirmed at autopsy.     

Spinal adrenal cortical adenoma with oncocytic features: report of the first intramedullary case and review of the literature

Ectopic adrenal cortical neoplasms are extremely rare, and only a few have involved the CNS. We report the first case of an intramedullary oncocytic adrenal cortical neoplasm of the spinal cord with immunohistochemical (IMHC) confirmation. A 27-year-old man presented with progressive lower extremity weakness, spastic paraparesis, decreased reflexes, and hypoesthesia below T10. A spinal myelogram showed cauda equina blockade and obliteration of sacral nerve roots. This prompted emergent surgical intervention. A well-circumscribed, approximately 3 x 2 cm, light brown to tan, intramedullary tumor was identified at the level of the conus medullaris. Histologically, the tumor showed sheets and nests of plump, cytologically bland polygonal cells with abundant eosinophilic cytoplasm. A single mitosis, but no necrosis, was identified. By IMHC, the cells were positive for inhibin, melan-A, and synaptophysin, and negative for GFAP, EMA, cytokeratins, S-100, HMB-45, and chromogranin. Electron microscopy study performed from paraffin-embedded tissues demonstrated abundant mitochondria, and lipid vacuoles. This case confirms the occurrence of adrenal cortical neoplasms in the CNS and is the first report of an intradural, intramedullary adrenal cortical adenoma of the spinal cord, and the first to occur in a male. This tumor should be considered in the differential diagnosis of tumors of the CNS.     

Cutaneous reactions to aspirin and nonsteroidal antiinflammatory drugs

Soon after the introduction of aspirin for the treatment of pain, fever, and inflammation more than a century ago, clinicians were challenged by the frequent observation of ASA-triggered allergic and pseudoallergic reactions occurring in the skin. This problem was further enhanced by the development of a number of other analgesic and antiinflammatory drugs that, having different chemical structures, cross-reacted with acetilsalycilic acid in many patients. This paper reviews the information presently available for the management of individuals who develop urticaria and angioedema when exposed to drugs that inhibit cyclooxygenase isoenzymes. The immune and nonimmunologic mechanisms leading to the pathogenesis of such reactions, their prevalence in selected groups of the population, clinical picture, and useful diagnostic approaches are described, and current guidelines used in our institutions for the clinical orientation of the patients, taking advantage of the recent introduction of various new and more selective NSAIDS that inhibit preferentially the COX-2 enzyme, are proposed.     

Influence of polarisation and differentiation on interaction of 43-kDa outer-membrane protein of Aeromonas caviae with human enterocyte-like Caco-2 cell line

It has been recognised that adherence and invasion to host cells are important steps in the pathogenesis of entero-pathogenic bacteria, including Aeromonas caviae. However, the virulence factors of A. caviae remain, for the most part, poorly known. This study examined the interaction of A. caviae isolates to Caco-2 cells in different polarisation and differentiation conditions. The adherence of A. caviae may be related to accessibility of host cell basolateral receptors. Aggregative A. caviae isolates, grown at 22 degrees C, were more adherent in both non-polarised and undifferentiated Caco-2 cells and EGTA-treated polarised and differentiated Caco-2 cells. Furthermore, monolayers pre-incubated with 43-kDa outer-membrane protein (OMP) or A. caviae strains pre-incubated with rabbit IgG anti-43-kDa OMP decreased adherence of some A. caviae strains to EGTA-treated polarised and differentiated Caco-2 cells, suggesting an interaction of 43-kDa OMP with basolateral cell receptors. Bacterial cells were observed adhering to microvilli and to plasma membrane on both the apical and basal surfaces of the monolayer. Pedestal-like formation with cytoskeletal rearrangement was also observed. The bacteria entered the Caco-2 cells and were observed enclosed in single and multiple membrane-bound vacuoles within the host cell cytoplasm. Furthermore, A. caviae were observed free in the cytosol of Caco-2 cells, suggesting escape form cytoplasmatic vacuoles.     

Oral contrast-enhanced three-dimensional helical-CT cholangiography: clinical applications

Our objective was to define the possibility of using oral-contrast-enhanced helical CT for the assessment of patients with cholecystolithiasis and of cholecystectomized symptomatic patients. Twenty-seven patients with cholecystolithiasis and 20 with a painful abdominal symptomatology after cholecystectomy (12 laparoscopic and 8 laparotomic) were recruited for this study. Cholangio-CT was performed 12–14 h after oral administration of 6 g of hyopanoic acid. The acquired data were then transferred to a second workstation and 3D reconstruction of the biliary tract was obtained. In all the cases the extrahepatic bile ducts were recognizable. Seven patients had no gallbladder opacification: CT images showed in 3 cases an infundibular stone and in 4 cases sclero-atrophic gallbladder. The intrahepatic bile ducts were visible in 21 of 27 patients with lithiasis and in 14 of 20 cholecystectomized patients. In 5 cholecystectomized patients cholangio-CT demonstrated the presence of residual choledochal or intrahepatic stones. In 3 cholecystectomized patients 3D reconstruction allowed identification of a long and winding stump of the cystic duct. Cholangio-CT is a non-invasive method to evaluate the biliary tract in patients who cannot be subjected to cholangio-MR, or as a preliminary to endoscopic retrograde cholangiopancreatography in cases of doubtful diagnosis after US and cholangio-MR. Electronic Publication