Mycobacterium intracellulare infection of the shoulder and spine in a patient with steroid-treated systemic lupus erythematosus

Atypical mycobacterial infections of bone are rare. A patient with systemic lupus erythematosus treated with steroids developed an M. intracellulare infection of the shoulder and spine. These infections are insidious and diagnosis is difficult. Marked involvement of one joint, large effusion, or aspirated small synovial fragments suggest an atypical tuberculous joint infection.     

Congenital lung malformations: a unified concept and a case report.

A left upper lobectomy in a 5-month-old infant revealed a specimen whose tissue, both grossly and microscopically, was characteristic of intr- and extrapulmonary swquestration, bronchial atresia, and adenomatoid cystic malformation. This case may be considered the missing link between the various congenital lung malformations, for it illustrates their interrelationship or their common origin. Atresia or malformation of the main bronchus seems to be the defect shared by all these anomalies. A similar bronchial abnormality probably is responsible for congenital lobar emphysema and isolated congenital lung cysts.     

The case: your diagnosis? Osteopoikilosis

Enostoses, osteomas, osteopoikilosis, osteopathia striata, and melorheostosis may simulate other diseases. However, the findings on imaging usually are characteristic enough to indicate the correct diagnosis.     

Acquired pendular nystagmus: its characteristics, localising value and pathophysiology

Investigations were made of 16 patients with acquired pendular nystagmus and a further 32 cases reported in the literature were reviewed. Amongst our own patients two thirds had multiple sclerosis, almost one third a cerebrovascular accident or angioma and two had optic atrophy with squint. The nystagmus took forms which could be monocular or binocular, conjugate or disconjugate and could involve movements about single or multiple axes. Spectral analysis was used to characterise the amplitude and frequency of the movements and to estimate the degree of relationship (coherence) between movements of the two eyes or between movements of one eye about several axes. The oscillations ranged in frequency from 2·5 Hz to 6 Hz, with typical amplitudes between 3° and 5°. In a given patient all oscillations, regardless of plane, were highly synchronised. Somatic tremors of the upper limb, face and palate associated with the nystagmus were often at similar frequencies to the eye movement. The other ocular signs common to all our patients were the presence of squint with failure of convergence. Most patients also had skew deviation or internuclear ophthalmoplegia or both. The major oculomotor systems, that is, saccades, pursuit, optokinetic and vestibulo-ocular reflexes could be intact. It is inferred that the mechanism responsible for the pendular nystagmus lies at a level which is close to the oculomotor nuclei so that it can have monocular effects but is not part of the primary motor pathways. It is possible that this mechanism normally subserves maintenance of conjugate movement and posture of the eyes. The periodicity of the nystagmus is likely to arise from instability in a certain type(s) of neurone, for the associated somatic tremors have similar characteristics and yet involve very different neuronal muscular circuitry. Prognosis for cessation of the nystagmus is poor. In five patients with multiple sclerosis it was suppressed by intravenous hyoscine with, however, unacceptable subsequent side effects.     

Normal excretory urography in patients with primary kidney neoplasms

The records of 65 consecutive patients discharged from the hospital with a diagnosis of primary parenchymal neoplasm of the kidney were reviewed. Four of the 65 patients had neoplasms which were not detected by excretory urography. The 4 undetected lesions included 3 renal cell carcinomas and 1 oncocytoma. All of these lesions projected from the anterior or posterior surface of the kidney, and all 4 were clearly demonstrated by computed tomography. Normal findings on an excretory urogram do not completely exclude a neoplasm of the kidney. When there is strong clinical suspicion of a renal neoplasm, computed tomography should be the initial examination or should be done even if the urogram has shown normal findings.     

Detection of musculoskeletal infection with 18F-FDG PET: review of the current literature

There are several studies on (18)F-FDG PET in the evaluation of musculoskeletal infection; however, a search of the literature failed to identify any large-scale studies. The 7 articles reviewed included 273 cases of suspected musculoskeletal infection evaluated by (18)F-FDG PET. This method was found to be sensitive and specific in the evaluation of chronic and acute osteomyelitis and prosthetic infection. Furthermore, (18)F-FDG PET was accurate in the evaluation of infection at previous surgical sites even within 12 mo of surgery. The current literature suggests that (18)F-FDG PET is a highly accurate method to detect musculoskeletal infection.