Heterotopic spinal cord?

Unusual morphological findings were encountered in a high cervical meningomyelocele sac of a neonate. Magnetic resonance imaging revealed a massive liquid-filled sac traversed by a linear structure. The spinal cord was seen to be located normally within the spinal canal. At operation, a spinal cord-like structure was identified within the sac. This cord terminated posteriorly at the neural tissue lining the meningomyelocele sac. There were fibrous strands connecting the cord to the sac like the rigging of a ship. The anterior end of this cord terminated in a fibrous band. It extended upwards into the spinal canal through the narrow neck of the meningoyelocele sac above the arch of the atlas. The whole of this cord, along with the meningomyelocele sac, was excised. Histological analysis confirmed that this spinal cord-like structure consisted of glial tissue with an ependymal-lined cavity. The excised sac was lined by neural tissue.     

Male breast carcinoma: an updated experience at a Veterans Administration Hospital and review of the literature

Ten cases of male breast carcinoma are reviewed. Male patients with breast cancer on the average are 10 years older than females, and they delay twice as long as females after noting a breast mass before seeking medical attention. Because of this patient's delay, male breast cancer tends to be more advanced at the time of diagnosis and initial therapy than female breast cancer.     

Pathogenesis of unilateral proptosis

A series of 34 patients presenting with unilateral proptosis has been studied in order to evaluate the mechanism of proptosis. It is observed that symmetrical (axial) proptosis is usually the result of generalised increase in intraorbital contents and occurs in thyroid disease and with intracranial lesions lying remote from the orbit. Rarely, in myasthenia gravis, it may be caused by myogenic paralysis of the extraocular muscles. Asymmetrical proptosis is the result of localised increase in intraorbital contents, and this occurs with expanding lesions of the orbit and in lesions arising from neighbouring structures and enroaching the orbit.     

How good is anticoagulation control in non-valvar atrial fibrillation? Observations on the elderly, ethnicity, patient perceptions, and understanding of AF thromboprophylaxis

There continues to be a wide variation of opinion among UK consultants regarding the best treatment strategies for ensuring effective thromboprophylaxis of atrial fibrillation.     

Fabry disease: an atypical presentation

Fabry disease is a rare X-linked recessive lysosomal storage disease. Patients typically have angiokeratomas distributed between the umbilicus and knees, painful crises of the hands and feet, and renal, ophthalmologic, and cardiac abnormalities. An 11-year-old boy presented with a 6-year history of widespread petechial-like lesions and painful crises of the hands and feet. On physical examination, he had numerous erythematous, nonblanching pinpoint macules and rare papules with an overlying crust. These lesions were widely distributed on his trunk, palms, and soles, while sparing the area between the umbilicus and knees. Histologic evaluation of one of these lesions found several dilated, blood-filled vessels in the upper dermis beneath a thinned epidermis. The patient also had markedly decreased alpha galactosidase A levels. Although the distribution of the angiokeratomas was atypical, the clinical and histologic findings were consistent with a diagnosis of Fabry disease.