Unusual cross-sectional imaging findings in hepatic peliosis

Hepatic peliosis is a rare entity that represents focal, multifocal, segmental, or diffuse dilatation of liver sinusoids. Hepatic peliosis is often associated with chronic wasting diseases but also has been reported in association with anabolic, contraceptive, or other hormonal treatment, and even in context with HIV-related bacterial infections. Hepatic peliosis is usually clinically unapparent and mostly found only during autopsy, but occasionally it may lead to diagnostic problems if detected radiologically since the imaging findings in hepatic peliosis are quite variable according to the variety of its possible histologic features as well as the possibility of additional hemorrhage. We present a case of hepatic peliosis associated with bronchial carcinoma that showed moderate centripetal enhancement during the portal-venous phase on CT, pronounced venous pooling on contrast enhanced T1-weighted images acquired during the hepatic-venous phase, and bright signal on T2-weighted images, thus mimicking in some way a capillary hemangioma. We also discuss some not yet described CT and MR features of this rare entity which should be included into the differential diagnosis of atypical liver lesions in patients with the above-mentioned conditions.     

Dissociations among functional subsystems governing melody recognition after right-hemisphere damage

This study describes an amateur musician, KB, who became amusic following a right-hemisphere stroke. A series of assessments conducted post-stroke revealed that KB functioned in the normal range for most verbal skills. However, compared with controls matched in age and music training, KB showed severe loss of pitch and rhythmic processing abilities. His ability to recognise and identify familiar instrumental melodies was also lost. Despite these deficits, KB performed remarkably well when asked to recognise and identify familiar song melodies presented without accompanying lyrics. This dissociation between the ability to recognise/identify song vs. instrumental melodies was replicated across different sets of musical materials, including newly learned melodies. Analyses of the acoustical and musical features of song and instrumental melodies discounted an explanation of the dissociation based on these features alone. Rather, the results suggest a functional dissociation resulting from a focal brain lesion. We propose that, in the case of song melodies, there remains sufficient activation in KB's melody analysis system to coactivate an intact representation of both associative information and the lyrics in the speech lexicon, making recognition and identification possible. In the case of instrumental melodies, no such associative processes exist; thus recognition and identification do not occur.     

Dispersive pad site burns with modern radiofrequency ablation equipment

Pad burns during or after radiofrequency ablation (RFA) are a skin complication probably underreported in the literature. We report on 4 severe pad burns, deep second and third degree, in 3 patients undergoing radiofrequency ablation of liver malignancies, 1 percutaneously and the other 2 after laparotomy. All burns occurred at the leading edge or at the corner of the pads attached to the patients' thighs. Potential causes leading to the burns are discussed. Current dispersive pad designs do not prevent the leading edge phenomenon and subsequent burns. Further developmental work in the pad design with the possibility of skin temperature monitoring via temperature sensors under the leading pad edge is needed.     

Fabrication of a Fixed Retrievable Implant‐supported Prosthesis Based on Electroforming: A Technical Report

This article describes a method of fabricating a fixed retrievable implant‐retained prosthesis based on electroforming. This method combines the advantages of both the cement‐ and screw‐retained prostheses, including passive fit, ease of fabrication, and retrievability. The absence of visible occlusal screw‐canals adds to its increased esthetic appeal.     

Carotid artery disease assessed by color Doppler flow imaging: correlation with standard Doppler sonography and angiography

Carotid artery disease was assessed in 180 patients by means of color Doppler flow imaging. Color Doppler findings in 360 carotid arteries were compared with the results of standard Doppler sonography, and color Doppler findings in 60 bifurcations were compared with the results of intraarterial angiography. The sensitivity of color Doppler for the detection of carotid disease was 100% when compared with angiography. The accuracy of color Doppler in classifying minor (40-60%), moderate (61-80%), and severe (81-90%) stenosis ranged from 91.3% to 97.8% vs standard Doppler sonography, and from 91.7% to 95.8% vs angiography. Whereas all occlusions were identified correctly by both color Doppler and angiography, four pseudoocclusions of the carotid artery were misdiagnosed as occluded. Characteristic features providing reliable criteria of the degree of stenosis are (1) intensity, extent, and duration of color fading; (2) postprocessed systolic peak frequency; (3) plaque extent on serial sonograms; and (4) poststenotic flow patterns. Display of hemodynamic disturbances induced by less pronounced plaques showed highly variable patterns that could not be anticipated from the plaque morphology alone. Thus, color Doppler preserves the advantages of standard Doppler and duplex sonography but provides additional information about otherwise anechoic necrotic and thrombotic material that often causes cerebral embolisms. With atherogenesis, repair mechanisms may be sustained or progression be stopped by reducing the risk factors and instituting medical treatment; thus, the application of this noninvasive technique is important.     

The natural progression of kidney injury in young type 1 diabetic patients

Diabetes is the most common cause of end-stage renal disease in industrialized countries. This article describes the structural changes in early diabetic nephropathy and the relationship with renal functional parameters, blood pressure, and albumin excretion. The detrimental influence of sustained hyperglycemia and/or glycemic fluctuations on renal structural change has been well documented. Tight glycemic control is paramount to preventing the development, and even the regression, of renal lesions. As much of the renal injury from diabetes occurs in clinical silence before symptoms or laboratory findings of renal injury are evident, finding early markers of risk is imperative so that nephropathy can be prevented. Currently, the only clinical surrogate marker of diabetic renal injury available is microalbuminuria. However, given the reports of regression of microalbuminuria back to normoalbuminuria, the reliability of this tool as an indicator of risk has been questioned. The need for alternative, noninvasive surrogate markers is described in this report.     

Schizencephaly: diagnosis and progression in utero

Schizencephaly is an unusual condition of obscure etiology. Most theories of pathogenesis postulate an in utero insult leading to maldevelopment rather than destruction of brain. The cause has most often been described as vascular or idiopathic dysgenesis. The authors report a case in which two in utero ultrasound (US) examinations performed at 31 and 36 menstrual weeks demonstrated progressive deterioration of the relatively narrow, symmetrical clefts connecting the lateral ventricles with the subarachnoid space into broad defects that corresponded to the entire distribution of the middle cerebral arteries. The findings in this case document progressive destruction of brain tissue in utero and are consistent with a vascular cause rather than a failure of formation of portions of the cerebral mantle.