Magnetic Resonance Imaging of Cauda Equina Syndrome in Ankylosing Spondylitis: A Case Report

A case of ankylosing spondylitis associated with massive dural ectasia is presented. Computed tomography and magnetic resonance imaging characteristics are shown, and possible causes are discussed.     

双(2,6-哌嗪二酮)类抗肿瘤药物的研究:2,3-二乙酰氧基-1,4-二(3′,5′-二酮-N4′-取代哌嗪甲基)苯的合成

Seventeen compounds having the structure of 2,3-diacetoxy-1,4-bis(3′,5′- dioxo-N⁴′-substituted piperazinyl methyl)benzene were designed and synthesized based on chelation hypothesis. Their antitumor activities on P388 cells,Hep cells and SGC 7901 cells in vitro were tested. Preliminary results showed that compound 4e has potent antitumor effect against P388 cells and.Hep cells in vitro.     

Diffuse Cerebral Air Embolism Treated With Hyperbaric Oxygen: A Case Report

A 54-year-old woman presented for cardiac evaluation of atypical chest pain. Workup included coronary angiography and a left ventriculogram, during which air was inadvertently injected, resulting in the development of an acute right hemisphere syndrome. Right carotid angiography was immediately performed, yielding only a delayed diffuse venous phase without focal vessel cutoffs. Within 60 minutes, the patient underwent hyperbaric oxygen therapy for the suspected cerebral air emboli. After removal from the chamber for technical reasons, she had a generalized tonic-clonic seizure, and further hyperbaric oxygen therapy was withheld. Initial computed tomography imaging obtained approximately 8 hours after symptom onset showed signs of early right hemispheric edema. Subsequent magnetic resonance imaging studies were markedly abnormal and suggestive of diffuse bilateral but predominantly right-sided parietal lobe edema with mildly positive diffusion-weighted imaging. Follow-up magnetic resonance imaging at 6 months was normal, and the patient's neurological examination returned to normal.     

Placenta accreta. Additional sonographic observations.

Recent reports describe the antenatal sonographic diagnosis of placenta accreta based on failure to visualize a hypoechoic zone at the placental margin. This finding was confirmed in our series of seven cases. New observations in this series include prominent large or multiple placental venous lakes and periuterine vascularity in six of seven cases, and progressive thinning and disappearance of the retroplacental hypoechoic zone on sequential examinations in two of seven cases. Loss of normal venous flow pattern on Doppler interrogation of the peripheral placental margin also appeared to be of value in two patients. Histologic correlates for these findings are suggested on the basis of the primary histopathologic feature of placenta accreta: deficiency of the decidua basalis. Differential diagnostic considerations, including abdominal pregnancy and trophoblastic disease, also are discussed.     

A method for analyzing therapist interventions in the psychotherapy of borderline patients

The authors developed a method for studying the therapist's use of technique in responding to specific patient themes during treatment of patients with borderline personality disorder. This method can monitor the use of expressive and supportive techniques as well as the congruence between patients' theme categories and the direction of the therapist's interventions. The method was developed to monitor adherence to an operationally defined treatment approach for psychodynamic psychotherapy of borderline patients. Data are presented on interrater agreement obtained with this method and on its application to 12 psychotherapy sessions.     

Naloxone-induced pulmonary edema

We present the case of a 68-year-old woman with acute pulmonary edema secondary to the administration of naloxone to reverse an inadvertent narcotic overdose. The patient presented following a 12-hour history of increasingly bizarre behavior and confusion. A total IV dose of 1.6 mg naloxone was administered in an attempt to reverse the suspected overconsumption of a codeine-containing cough suppressant. She immediately became agitated, tachycardic, and diaphoretic; a clinical diagnosis of acute pulmonary edema was made. Following treatment with furosemide, nitroglycerin, and morphine sulfate, the patient recovered completely without further incident. Although naloxone is thought to be a safe drug with few complications, it should not be used indiscriminantly, and the smallest doses necessary to elicit the desired response should be used.     

Assaultive behavior among psychiatric outpatients

Of 2,916 patients evaluated by psychiatric residents in the outpatient clinics of two large private psychiatric hospitals, 3% had manifested recent assaultive behavior toward other persons. In over half the cases the target of assault was a family member other than a child. Patients more likely to be assaultive were young and male and had a diagnosis of childhood or adolescent disorder or personality disorder. The authors compare these results with those from studies of assault among inpatients and recommend that physicians in outpatient as well as inpatient settings be familiar with the management of assaultive patients.     

Common Epstein-Barr virus (EBV) type-1 variant strains in both malignant and benign EBV-associated disorders

In the present study, Epstein-Barr virus (EBV) isolates from 18 malignant tumors (angioimmunoblastic lymphadenopathy [AILD], n = 4; Hodgkin's disease [HD], n = 3; pleomorphic T-cell non-Hodgkin's lymphoma [T-NHL], n = 1; B-cell non-Hodgkin's lymphoma [B-NHL], n = 8; gastric carcinoma, n = 2) as well as from 10 tonsils of EBV- seropositive children and from peripheral blood mononuclear cells of 12 children with uncomplicated infectious mononucleosis (IM) and of a boy with severe chronic active EBV infection were genotyped in the EBV nuclear antigen-2 (EBNA-2) gene. A total of 40 of 41 isolates harbored EBV type 1; in 1 specimen (tonsil), only EBV type 2 was found. Further molecular characterization of EBV type-1 wild-type isolates in the EBNA- 2 gene and in the 40-kb distant EBV-encoded small RNAs (EBER) region showed that different groups of stable EBV type-1 variant strains exist in vivo both in benign and malignant lymphatic tissue. Group 1 is composed of EBV type-1 isolates (B-NHL, n = 3; T-NHL, n = 1; HD, n = 1; IM, n = 4) that showed a B95-8-like DNA sequence pattern in both viral genes. Group 2 isolates (HD, n = 1; AILD, n = B-NHL, n = 1; tonsils of EBV-seropositive children, n = 9; IM, n = 20 showed a nucleotide change at position 49095 in the EBNA-2 gene, leading to an amino acid substitution (Pro-->Ser), and EBV type-2 sequences in the EBER region. EBV type-1 isolates that fall into group 3 (AILD, n = 3; HD, n = 1; B- NHL, n = 4; gastric carcinoma, n = 2; IM, n = 6; severe chronic active EBV infection, n = 1) were characterized by typical nucleotide changes and a 3-bp insertion (CTC; extra Leu residue) in the EBNA-2 gene and an EBV type-2-specific sequence pattern in the EBER region. These EBV type- 1 variant strains may represent the most prevalent circulating EBV type- 1 strains in the exposed population and seem not to be restricted to a certain EBV-associated disease or tumor type. However, analysis of more EBV isolates from benign and malignant lesions must show whether more EBV type-1 substrains exist in vivo.