Superior vena cava and right atrial thrombus detected on lung perfusion scintigraphy

Ventilation and perfusion scanning is still used as the first modality for evaluating pulmonary embolism in pregnant and renal failure patients and those who are allergic to radiographic contrast. Hot spots in the right atrial area on perfusion scan are the result of the presence of thrombi. These thrombi are of 2 varieties. One type is a free-floating thrombus, which needs emergency thrombectomy, and another type is thrombus formation in the atria, predisposed by the presence of catheters. We report a study showing essentially normal perfusion but intense tracer uptake in the superior vena cava and right atrium. Noncontrast computed tomography confirmed the thrombus.     

Pathogenic Yersinia DNA is detected in bowel and mesenteric lymph nodes from patients with Crohn's disease

Previously, we detected pathogenic (invasive) DNA in the appendices of two patients who later developed Crohn's disease (CD). This subsequent investigation is the first to evaluate a series of specimens from CD patients for the presence of pathogenic DNA. A total of 54 intestinal resection specimens from 52 patients with confirmed CD were evaluated. Lesional tissue was tested by polymerase chain reaction analysis for the presence of genes occurring only in pathogenic Primer pairs are specific for each species, with no known cross reactions with other bacteria. Forty normal bowel specimens, 30 cases of acute appendicitis, and 50 cases of various active colitides served as disease controls. Medical records were reviewed following polymerase chain reaction and histologic evaluation. A total of 17 of 54 resections (31%) contained DNA by polymerase chain reaction. Mesenteric lymph nodes were also positive in eight of these cases. All controls were negative. -positive patients had carried the diagnosis of CD for a median of 10 years before resection (range 1 month to 40 years). We report the first documentation of DNA in a series of CD cases. Further studies are needed, including serial study, over time, of -positive CD patients, as well as prospective studies of newly diagnosed CD patients for evidence of infection. Like previous studies associating infectious organisms with CD, much work remains to elucidate whether the presence of DNA is an epiphenomenon or actually a factor in the pathogenesis of CD.     

Primary intraosseous meningioma of orbit and anterior cranial fossa: a case report and literature review

Primary intraosseous meningiomas of the skull base are rare. Extensive involvement of the skull base by the tumour may result rarely in loss of vision. Surgical management requires extensive decompression and reconstruction. A case of primary intraosseous meningioma of orbits and anterior cranial fossa presenting with painless proptosis and loss of vision is presented here and the literature reviewed.     

Comparative in vitro activity of three fluoroquinolones against clinical isolates by E test

The in vitro susceptibility of levofloxacin, ciprofloxacin and moxifloxacin against several gram-positive and gram-negative clinical isolates was tested by E test. We found that the MIC(50) and MIC(90) values against all members of the Enterobacteriaceae family except Serratia were <0.5 mg/l for ciprofloxacin and levofloxacin (MIC range 0.006-32 mg/l) based on the in vitro susceptibility data. The susceptibility rates for ciprofloxacin and levofloxacin were more than 85% for Escherichia coli, citrobacter, enterobacter cloacae, enterobacter aerogenes and Klebsiella pneumoniae, although Serratia and Acinetobacter exhibited more or less similar susceptibility rates (about 80%). Pseudomonas aeruginosa demonstrated significant resistance to fluoroquinolones (MIC(90) >32 mg/l) and decreased bactericidal rates (<65%) to levofloxacin and ciprofloxacin. Respiratory pathogens such as Streptococcus pneumoniae and Haemophilus influenzae were highly susceptible (100%) to levofloxacin and moxifloxacin. The ineffectiveness of fluoroquinolones for treating coagulase-positive Staphylococcus aureus was demonstrated by poor in vitro susceptibility rates with levofloxacin (52%) and moxifloxacin (57%). Coagulase-negative staphylococci demonstrated significantly decreased bactericidal rates to levofloxacin (21%), while the in vitro susceptibility to moxifloxacin was higher (66%) than that to levofloxacin. We propose that the beneficial effect of inclusion of any of these three fluoroquinolones in treating Enterococcus infections is marginal, as demonstrated by significantly reduced susceptibility rates (<32%). These data demonstrate the utility of fluoroquinoles to treat several gram-negative bacterial infections (with the exception of Acinetobacter and P. aeruginosa), as well as S. pneumoniae and H. influenzae.     

Esophageal duplication cyst causing unilateral hyperinflation of the lung in a neonate

Esophageal duplication cysts are rare congenital anomalies. Frequently asymptomatic, they may cause respiratory distress and feeding difficulties in infants. Unilateral hyperinflation of the lung due to compression of the bronchus by the cyst is rare. We report a case of a 4-day-old male neonate presenting with respiratory distress who had an esophageal duplication cyst causing obstructive hyperinflation of the right lung. The nature of the cyst was confirmed after surgery.