Pilomatrix carcinoma of the face. Two case reports

Pilomatrixial carcinoma is the malignant variety of pilomatrixoma. It is a malignant lesion, locally aggressive that can reappear, specially if not completely removed. Scanty are the number of cases listed in the literature (2). Although metastases are uncommon one or twice references can be found in the writings (1). We report 2 cases of pilomatrixial carcinoma located in the middle canthal and malar zones, which were treated surgically: excision of the tumor and reconstruction by means of a local rotation flap.     

Spinal flexibility and balance control among community-dwelling adults with and without Parkinson's disease

BACKGROUND: One area of research that requires further elaboration is the relationship between impairments and functional limitations. By identifying specific contributors to functional limitations, it may be possible to establish intervention strategies, including exercise approaches, that can delay or ameliorate decline in function. The association between impaired spinal flexibility and functional limitations has not been studied in depth. The purposes of this study were to determine (a) the associations between spinal flexibility and functional limitations; (b) the relative contribution of spinal flexibility to specific functional limitations; and (c) how disease state (Parkinson's disease [PD] vs no PD) modified these relationships. METHODS: Participants included 251 community-dwelling adults, 56 of whom were with diagnosed PD and 195 were without PD or other specific disorders. Measures included spinal flexibility (i.e., functional axial rotation [FAR]) and configuration (i.e., thoracic kyphosis and lumbar lordosis), functional limitations (i.e., functional reach, supine-to-stand time, 10-m walk, and 360 degrees turn). RESULTS: Canonical correlation (Can R) demonstrated significant associations between spinal measures and functional limitations (Can R = .488, p = .0001). After controlling for age, gender, race, body mass index, comorbidity, confidence, and depression, a multivariate regression model demonstrated that spinal flexibility contributed significantly to functional reach (R2 = .334 for the overall model, p = .0001). Based on the parameter estimate of 0.026, the results prediet that FAR accounts for a 4.6-inch difference in reach distance between the least and most flexible of the participants. In addition, there were significant differences between almost all measurements for the PD compared with the non-PD participants. CONCLUSION: Results clearly implicate spinal flexibility as a contributor to functional reach, a measure of functional limitation and an established measure of balance control. Further work is needed to determine the extent to which spinal flexibility can be improved and the effect of that improvement on balance.     

Relative Contributions of Lipooligosaccharide Inner and Outer Core Modifications to Nontypeable Haemophilus influenzae Pathogenesis

Nontypeable Haemophilus influenzae (NTHi) is a frequent commensal of the human nasopharynx that causes opportunistic infection in immunocompromised individuals. Existing evidence associates lipooligosaccharide (LOS) with disease, but the specific and relative contributions of NTHi LOS modifications to virulence properties of the bacterium have not been comprehensively addressed. Using NTHi strain 375, an isolate for which the detailed LOS structure has been determined, we compared systematically a set of isogenic mutant strains expressing sequentially truncated LOS. The relative contributions of 2-keto-3-deoxyoctulosonic acid, the triheptose inner core, oligosaccharide extensions on heptoses I and III, phosphorylcholine, digalactose, and sialic acid to NTHi resistance to antimicrobial peptides (AMP), self-aggregation, biofilm formation, cultured human respiratory epithelial infection, and murine pulmonary infection were assessed. We show that opsX, lgtF, lpsA, lic1, and lic2A contribute to bacterial resistance to AMP; lic1 is related to NTHi self-aggregation; lgtF, lic1, and siaB are involved in biofilm growth; opsX and lgtF participate in epithelial infection; and opsX, lgtF, and lpsA contribute to lung infection. Depending on the phenotype, the involvement of these LOS modifications occurs at different extents, independently or having an additive effect in combination. We discuss the relative contribution of LOS epitopes to NTHi virulence and frame a range of pathogenic traits in the context of infection.     

Team approach to treatment of the posttraumatic stiff hand. A case report

Posttraumatic hand stiffness is a common but complex problem treated in many general clinics and in hand treatment centers. Although much information is available regarding various treatment procedures, the use of a team approach to evaluate and treat hand stiffness has not been examined thoroughly in the Journal. The problems of the patient with a stiff hand include both physical and psychological components that must be addressed in a structured manner. The clinical picture of posttraumatic hand stiffness involves edema, immobility, pain, and the inability to incorporate the affected extremity into daily activities. In this case report, we review the purpose and philosophy of the team approach to hand therapy and the clarification of responsibilities for physical therapy and occupational therapy intervention.     

Diagnostic Value of Early Secreted Antigenic Target-6 for the Diagnosis of Tuberculous Meningitis Patients

Background:   

The early diagnosis of tuberculous meningitis (TBM) is very crucial, since delayed diagnosis can lead to various neurological manifestations. We have previously developed an in-house indirect enzyme-linked immunosorbent assay (ELISA) for TBM diagnosis using the Antigen 85 (Ag 85) complex. It has been suggested that the Ag 85 complex might give false-positive reactions for individuals vaccinated with Bacillus Calmette-Guérin (BCG).     

Utilization of screening mammography: comparison of different physician specialties

Data obtained on 426 consecutive patients referred to a breast center by 122 physicians, including family practitioners, general surgeons, and other specialists, showed that the obstetricians-gynecologists referred the greatest average number of patients per physician, with more than 50% of these referrals for screening mammography. Internists referred fewer patients by nearly a factor of ten, with only one-third of these patients referred for screening mammography. Internists may be the weakest link in the utilization of screening mammography.     

Immunohistochemical localization of neurotropic ecotropic murine leukemia virus in moribund mice

The CasBrE strain of neurotropic ecotropic murine leukemia virus (NE-MuLV) infects susceptible mice and induces a noninflammatory, slowly degenerative nervous system disease. We employed immunohistochemistry to identify which cells in the nervous system and other tissues contained viral antigen in the chronically infected mouse. Rabbit antiserum to the virus was prepared using different combinations of whole virus and synthetic peptides corresponding to a 14-amino-acid sequence of the viral envelope protein. Twenty-four of forty-four (55%) mice neonates inoculated intracranially with NE-MuLV developed symptoms ranging from tremulousness to hindlimb paralysis within 3-9 months. They were subsequently sacrificed and their tissues used for histology and immunohistochemistry. The major locations of viral antigen outside of the central nervous system (CNS) were skeletal muscle and spleen. Skeletal muscle was the only non-nervous system tissue that exhibited degenerative changes as atrophy of viral antigen-bearing oxidative myofibers. In the CNS, viral antigen was detected in neurons, endothelium, and glial cells. Immunohistochemical double-labeling studies for viral antigen and the astrocytic marker glial acidic fibrillary protein (GFAP) demonstrated that the viral antigen-containing glia were oligodendrocytes and not astrocytes. Tissue damage in the brain consisted of vacuolar changes and gliosis principally in the brainstem. Viral antigen was most abundantly localized in these regions of pathologic change. In the spinal cord a different pattern was observed. Although tissue damage was observed throughout the cord, viral antigen was located at the border of the gray and white matter. These findings indicate direct and indirect virus-mediated mechanisms of damage to the CNS.