Scintigraphic imaging of knee synovitis in osteoarthritis after intra-articular injection of technetium-99m pertechnetate in the unilateral knee

A case of left knee synovitis scintigraphic imaging is presented in a 66-year-old patient with bilateral knee osteoarthritis and a right knee Baker's cyst, who had undergone a 74 MBq (99m)Tc-pertechnetate intra-articular injection in the right knee. The findings in this case were compared with the intravenously injected methylene disphosphonate technetium-99m ((99m)Tc-MDP) scintigraphic findings and could be interpreted as the result of (99m)Tc-pertechenate through blood communication from the right to the left knee. This case implies that (99m)Tc-pertechnetate may be useful in imaging the synovitis in multiple arthroses even up to 60 min after its administration, instead of the 5 min imaging after the injection of (99m)Tc-MDP.     

Cutaneous Crohn''s disease mimicking Melkersson–Rosenthal syndrome: treatment with methotrexate

A woman with a 5-year history of unilateral orofacial granulomatosis required repeated evaluations (including sequential colonoscopies) to establish the diagnosis of cutaneous Crohn's disease, a condition that proved responsive to low doses of oral methotrexate administered weekly. To our knowledge this is the first report describing the use of methotrexate for treatment of orofacial granulomatosis caused by underlying Crohn's disease.     

Naevus lipomatosus cutaneous superficialis

A young male presenting with cutaneous papules and plaques in a segmental distribution in the pelvic girdle area is reported. The clinical features were suggestive of naevus lipomatosus cutaneous superficialis, but diagnostic biopsy is essential to demonstrate the typical histopathological features and exclude important differential diagnoses such as segmental neurofibromatosis.     

Penetration of Colistin into Cerebrospinal Fluid

Colistin penetration into the cerebrospinal fluid (CSF) was studied in five critically ill adult patients receiving colistin methanesulfonate for infections by multiresistant gram-negative bacilli. Colistin concentrations were determined in paired serum and CSF samples, with the latter taken by lumbar puncture, with the exception of one patient with an external ventriculostomy. CSF-to-serum ratios (0.051 to 0.057) for all study patients coincided at all sampling times. The low level (5%) of penetration suggests inadequate bactericidal colistin concentrations in the CSF.Several case reports have described the successful treatment of central nervous system (CNS) infections with colistin (in the form of colistin methanesulfonate [CMS]) administered intravenously and/or either intrathecally or intraventricularly (2, 7-11, 16). However, initial data derived from colistin concentrations measured by microbiological assay suggested poor drug penetration into the cerebrospinal fluid (CSF), which was not enhanced in the presence of meningeal inflammation (5), while more recently, a 25% peak CSF-to-serum concentration ratio (8) and a ∼15% ratio of areas under the CSF/serum concentration-time profiles were reported (9). These findings raise concerns about the effectiveness of intravenous (i.v.) CMS monotherapy. Furthermore, as the data (5, 8, 9) relating to the penetration of colistin into the CSF are based solely on unreliable bioassay measurements, these have to be confirmed by high-performance liquid chromatography, which is now considered to be the only valid approach for quantifying colistin levels (12).In order to determine the CSF penetration of colistin after i.v. administration of CMS, we performed a prospective study of five nonconsecutive critically ill adult patients treated with i.v. CMS for serious gram-negative infections (not necessarily CNS infections) (Table ​(Table1).1). All patients had CSF withdrawn either for diagnostic reasons (suspected meningitis or ventriculitis) or for the follow-up of a documented CSF infection. The study was approved by the Hospital Ethics and Research Committee and performed in accordance with good clinical practice guidelines. Informed consent was waived.

TABLE 1.

Characteristics of the patients investigated^a

Malignancy may adversely influence the quality and behaviour of oocytes

A case series of eight cycles of in-vitro fertilization (IVF) in five women diagnosed with malignant disorders is presented. These patients chose to defer definitive treatment for a chance for preservation of potential fertility. The response of these patients to ovarian stimulation, and the outcome, was compared with 17 IVF cycles in 12 age- matched patients with isolated tubal infertility. An apparent adverse influence of malignant disease on the quality and behaviour of oocytes was observed. Despite a comparable total number of oocytes per cycle in the two groups, a significantly reduced percentage of mature oocytes was retrieved per cycle from patients with malignant diseases. The oocytes from patients with malignant disorders were of a poorer quality and exhibited a significantly impaired fertilization rate compared to the controls. We propose that neoplastic processes, irrespective of the site or cell of origin, may have a detrimental impact on the biology of oocytes, an effect akin to that seen on spermatozoa in men with certain malignancies.      

Withdrawal following cocaine self-administration decreases regional cerebral metabolic rate in critical brain reward regions

The quantitative [¹⁴C]-2-deoxyglucose autoradiographic method was utilized to assess regional cerebral metabolic rate for glucose (rCMR_glc) in rat brain during withdrawal from cocaine self-administration. RCMR_glc was determined in 62 regions from brains of naïve rats which were placed into an empty operant chamber for 12 hr continuously, and rats trained to self-administer cocaine during 3 hr training sessions and subsequently placed into the operant chamber for 12 hr continuously with or without access to cocaine. Animals placed into the chamber without access to cocaine were examined 6 hr later, while animals allowed access to the 12 hr cocaine binge were examined either 6 or 72 hr post-cocaine. Metabolic activity was reduced during withdrawal in the nucleus accumbens, olfactory tubercle, islands of Calleja region, basolateral and central amygdaloid nuclei, medial septum, piriform and cingulate cortices, rostral caudatoputamen, entopeduncular nucleus and the adjacent lateral hypothalamus, somatosensory, auditory, and motor cortices compared to the naïve state. These effects were usually more severe at 72 than at 6 hr after binge exposure, with intermediate values observed in cocaine trained animals without binge exposure. The response was negatively correlated with the amount of cocaine consumed during binge exposure in the striatum, olfactory tubercle, piriform, cingulate, somatosensory, and motor cortices. Thus, the amount of cocaine consumed can affect the extent of metabolic depression after sustained drug exposure. The pattern of regional effects suggests that mesolimbic and rostral extrapyramidal dopamine terminal regions and certain of their efferent pathways are preferentially affected during cocaine withdrawal. The reduction of basal metabolic rate observed in these brain regions during cocaine withdrawal may become more severe with time despite the apparent recovery of certain behavioral-motivational responses. © Wiley-Liss, Inc.