Paranasal sinus mucocele in cystic fibrosis

The relationship between cystic fibrosis, nasal polyposis and chronic sinusitis is clearly defined. Mucoceles of the paranasal sinuses, however, are a well-described complication of chronic sinusitis in adults; but they rarely occur in the pediatric age group. We report a three-year-old who presented with epiphora and fullness at the right medial canthus. Computed tomography confirmed a right ethmoid mucocele which was surgically drained, with resolution of symptoms. Approximately 12 other cases of mucoceles have been reported in the pediatric age group. Although many of these patients had recognized cystic fibrosis, some were previously undiagnosed. Only after presentation with a mucocele, did sweat testing reveal their underlying pathology. No pediatric patients in the literature were found with mucoceles and normal sweat tests. Paranasal sinus mucoceles may be diagnostic of cystic fibrosis and may be the presenting sign in some patients.     

Pediatric urology

Development of the genital and urinary systems is interwoven. Developmental abnormalities may cause problems in both systems, although the presenting problem may be ambiguous genitalia, hypospadias, undescended testis, or a urinary tract infection. The primary care physician must understand the underlying significance of pediatric urologic problems and seek appropriate consultation in a timely manner.     

The edematous hand

The purpose of this article is to increase the therapist's awareness of the effects of edema on the hand and the need for early treatment. The physiology of tissue fluid production and the two basic types of edema are discussed. The use of elevation, compression, and active exercise are the primary methods of controlling edema in the hand. Various modalities and commercial compression dressings are helpful for intractable edema; however, early intervention and treatment of the edematous hand can prevent subsequent hand dysfunction and sequelae.     

Prolonged running does not improve muscle coordination after cross-union of tibial and peroneal nerves in mice

Several months after cross-union of the tibial and peroneal nerves and full muscle reinnervation motor behavior was monitored and was tested by electromyographic recordings from both musculus tibialis anterior (TA) and musculus gastrocnemius medialis (MG). In addition spinal motoneuron pools were labelled by injecting wheat-germ agglutinin-horseradish peroxidase (WGA-HRP) into experimental and control TA muscles. Though the location of TA motoneurons was similar in all 9 mice tested and suggested successful cross-reinnervation, running behavior and EMG patterns varied remarkably. In some animals the alternating activities of TA and MG muscles remained more or less clearly separated from each other but were out of phase with the running cycle. A somewhat better motor behavior was accompanied by simultaneous activity in both muscles. Voluntary running in wheels for several kilometers per day did not visibly improve motor coordination indicating the absence of activity-related synaptic readjustments.     

Vestibular testing in comatose patients

The analysis of vestibular responses in a comatose patient often provides the critical information for making a correct preliminary diagnosis and directing the subsequent laboratory evaluation. Because of some uncertainties about what is being tested with the various bedside maneuvers that are used to elicit vestibular responses, we review the physiologic basis for the oculomotor responses that occur with head rotation or with caloric stimuli. We further urge precise and unambiguous terminology to describe both stimulus and response. We suggest using physiologically well-defined terms such as vestibulo-ocular reflex and cervico-ocular reflex and avoiding potentially misleading terms such as the doll's head and the oculocephalic maneuvers.     

Paratesticular desmoid tumor

A primary intrascrotal mass clinically mimicking a testicular tumor was found to be a desmoid tumor originating from the spermatic cord. To our knowledge, this is the first reported case of a paratesticular desmoid tumor.