Mononeuropathy multiplex due to infiltration of lymphoma in hematologic remission

We report a case of progressive mononeuropathy multiplex in a patient with lymphoma in hematologic remission. At the time of presentation there was no evidence of meningeal or central nervous system metastasis. At autopsy, extensive infiltration of tumor cells was found in both femoral nerves. We review the literature pertaining to multifocal malignant lymphoid infiltration of peripheral nerves, which can occur during hematologic remission or in the absence of any evidence of systemic lymphoma. © 1998 John Wiley & Sons, Inc. Muscle Nerve 21:823–826, 1998.     

Pyogenic granuloma following Smart Plug insertion

CASE REPORT: We report the case of a 65-year-old woman with dry eye syndrome who was referred because of a red mass in the internal left canthus. Three years previously two Smart Plugs had been introduced into both lacrimal punctums of that eye. We diagnosed a pyogenic granuloma and removed it. Two weeks later a new granuloma developed so both the granuloma and the punctal plug were removed. The patient became asymptomatic following this latter procedure. DISCUSSION: A pyogenic granuloma in a Smart Plug punctum is described. This rare complication is generally associated with the use of silicone punctal plugs, being possibly caused by the chronic irritation of the accumulated detritus and necessitating removal of the plug.     

Dacryocystitis caused by Candida lusitaniae

CASE REPORT: We report the case of a 60-year-old woman with recurrent dacryocystitis of the right lacrimal sac. She did not recover after medical treatment, nor after dacryocystorhinostomy with canalicular intubation. She also had dacryocystitis on the left side. The material that was obtained during surgery was grown in a culture medium and Candida Lusitaniae was identified as the responsible organism. All symptoms disappeared after topical treatment with amphotericin B and dacryocystorhinostomy. DISCUSSION: Dacryocystitis caused by Candida Lusitaniae is very rare. We should always consider whether Candida Lusitaniae is responsible for the primary infection or is the agent resulting from a superadded infection caused by previous antibiotic therapy.     

Pediatric Digit Replantation Following Traumatic Amputation: Nationwide Analysis of Patient Selection,Outcomes, and Cost

Background: Indications for replantation following traumatic digit amputations are more liberal in the pediatric population than in adults, but delineation of patient selection within pediatrics and their outcomes have yet to be elucidated. This study uses a national pediatric database to evaluate patient characteristics and injury patterns involved in replantation and their outcomes. Methods: The Healthcare Cost and Utilization Project Kid’s Inpatient Database was queried for traumatic amputations of the thumb and finger from 2000 to 2012. Participants were separated into those who underwent replantation and those who underwent amputation. Patients undergoing replantation were further divided into those requiring revision amputation and/or microvascular revision. Patient age, sex, insurance, digit(s) affected, charges, length of stay, and complications were extracted for each patient. Results: Traumatic digit amputations occurred in 3090 patients, with 1950 (63.1%) undergoing revision amputation and 1140 (36.9%) undergoing replantation. Younger patients, those with thumb injuries, females, and those covered under private insurance were significantly more likely to undergo replantation. Cost, length of stay, and in-hospital complications were significantly greater in replantation patients than in those who had undergone amputation. Following replantation, 237 patients (20.8%) underwent revision amputation and 209 (18.3%) underwent vascular revision, after which 58 required revision amputation. Risk of revision following replantation involved older patients, males, and procedures done recently. Conclusions: Pediatric patients who underwent replantation were significantly younger, female, had thumb injuries, and were covered by private insurance. Our findings demonstrate that in addition to injury factors, demographics play a significant role in the decision for finger replantation and its outcomes.     

Hiding the Rabbit: Using a genetic algorithm to investigate shape guidance in visual search

During visual search, attention is guided by specific features, including shape. Our understanding of shape guidance is limited to specific attributes (closures and line terminations) that do not fully explain the richness of preattentive shape processing. We used a novel genetic algorithm method to explore shape space and to stimulate hypotheses about shape guidance. Initially, observers searched for targets among 12 random distractors defined, in radial frequency space, by the amplitude and phase of 10 radial frequencies. Reaction time (RT) was the measure of “fitness.” To evolve toward an easier search task, distractors with faster RTs survived to the next generation, “mated,” and produced offspring (new distractors for the next generation of search). To evolve a harder search, surviving distractors were those yielding longer RTs. Within eight generations of evolution, the method succeeds in producing visual searches either harder or easier than the starting search. In radial frequency space, easy distractors evolve amplitude × frequency spectra that are dissimilar to the target, whereas hard distractors evolve spectra that are more similar to the target. This method also works with naturally shaped targets (e.g., rabbit silhouettes). Interestingly, the most inefficient distractors featured a combination of a body and ear distractors that did not resemble the rabbit (visually or in spectrum). Adding extra ears to these distractors did not impact the search spectrally and instead made it easier to confirm a rabbit, once it was found. In general, these experiments show that shapes that are clearly distinct when attended are similar to each other preattentively.     

How do older ventilated patients fare? A survival/functional analysis of 641 ventilations

Background

The outcome of mechanical ventilation in elderly patients should be evaluated by integrating survival rates with functional state over time after the ventilation episode.

Objectives

The aim of this study was to measure the survival rate and functional state of elderly ventilated patients and to present an integrated analysis of both outcome measures.

Methods

This is a prospective observational, noninterventional study of 641 invasive medical ventilations of elderly (65+ years) patients in medical wards and intensive care units.The functional state, by the Functional Independence Measure scale, was measured before hospitalization, at discharge from the hospital, and 1 year later.

Results

Survival rates at the end of hospitalization and 3, 6, and 12 months later were 33%, 28%, 25%, and 22%, respectively. According to a combined survival/functional analysis, only 11% of all ventilated elderly patients were doing well (Functional Independence Measure scale score, ≥90) a year after the hospitalization. The rates for this condition ranged from 23% for acute exacerbation of chronic obstructive pulmonary disease to 0% for stroke and hospital-acquired pneumonia.

Conclusions

In elderly patients treated with mechanical ventilation, the outcomes in the period immediately after ventilation and later on are poor. In this group of patients, functional outcomes should be integrated with survival analysis for a meaningful assessment of the outcomes of treatment with mechanical ventilation to provide patients, families, practitioners, and society with reliable information on which life or death decisions can be based.