Primary anal mucinous adenocarcinoma: A case series

Primary mucinous adenocarcinoma is a rare malignancy of the anus (3% of anal cancers), the pathogenesis of which is better understood by immunohistochemistry.We reviewed cases of primary mucinous adenocarcinoma of the anus from 2000 to 2009 in the Hepatogastroenterology Department of the University Hospital Centre of Marrakech.Three cases were identified who were males with the mean age of 68 years, and presented with a chronic anal fistula. Two cases had anal pain. Clinical examination revealed multiple fistulae in two cases with a secretion simulating ‘cooked grains of tapioca’. Diagnosis was confirmed by histopathology and immunohistochemical profile (CK7 positive/CK20 negative). Imaging revealed a retro-rectal collection with thickening of the anal wall without metastasis (two cases). One patient underwent abdominoperinal resection without recurrence.     

Changes in gait while backward counting in demented older adults with frontal lobe dysfunction

BACKGROUND: Gait disorders caused by dementia have been associated with frontal lobe dysfunction. Dual-tasking is used to explore the involvement of cortical level in gait control. It has been shown that dual-task induced gait changes that could be related to (1) the efficiency of executive function, (2) the level of difficulty involved in the walking-associated task, or (3) the articulo-motor components comprised in the walking-associated task. A better understanding of dual-task related changes in demented subjects with frontal lobe dysfunction could help us to clarify the role of the frontal lobe in motor gait control. OBJECTIVE: To assess and compare the effects of two mental arithmetic tasks involving similar articulo-motor components but different level of difficulty on the mean values and coefficient of variation (CV) of stride time among demented older adults with impaired executive function. METHODS: The mean values and coefficients of variation of stride time were measured using a GAITRite-System among 16 demented older adults with impaired executive function while walking with and without forward counting (FC) and backward counting (BC). RESULTS: The mean values and CV of stride time were significantly higher under both dual-task conditions than during a simple walking task (p<0.05). The change in CV of stride time during BC was significantly higher when compared with the change during FC (p=0.015), whereas the change in mean value was not significant (p=0.056). There was no difference between the dual-task and single task condition as far the number of enumerated figures were concerned (p=0.678 for FC and p=0.069 for BC), but significantly fewer figures were enumerated while BC compared with FC (p<0.001). CONCLUSION: BC provoked more changes in gait parameters than FC with major modification in gait variability related to an inappropriate focusing of attention. These findings suggest that the CV may be a suitable criterion for the assessment of gait control.     

Systemic effects of epidural and intra-articular glucocorticoid injections in diabetic and non-diabetic patients

IntroductionWhereas the systemic effects of glucocorticoid therapy have been extensively reported, little is known about those of local glucocorticoid injections. The objective of this study was to look for systemic effects of local glucocorticoid injections at two sites in diabetic and non-diabetic patients.MethodsWe studied 29 patients (18 women and 11 men with an age range of 18–86 years). The injection site was the epidural space in 18 patients (4 with and 14 without diabetes) with disk-related sciatica and the shoulder in 11 patients (8 with and 3 without diabetes) with frozen shoulder. Each patient was given three injections of 1.5 ml cortivazol (5.625 mg of cortivazol or about 85 mg prednisone-equivalent per injection and about 250 mg prednisone-equivalent in all), at 3-day intervals. Of the 12 patients with diabetes, 2 were on insulin therapy. At baseline and at the post-treatment visits 1, 7, and 21 days after the third injection, the following tests were done: plasma cortisol and ACTH at 8 am, urinary free cortisol excretion in 24 hours, fasting and postprandial blood glucose, serum cholesterol and triglycerides, and serum sodium and potassium. Blood pressure was measured at each visit.ResultsMean systolic blood pressure increased significantly between baseline (123 ± 10 mmHg) and the first two post-treatment visits (day 1, 127 ± 9 mmHg; and day 7, 128 ± 10 mmHg) but returned to baseline values by the third post-treatment visit (day 21). Mean postprandial blood glucose was significantly higher at the day 1 post-treatment visit (10.1 ± 5.4 mmol/l) than at baseline (7.5 ± 2.9 mmol/l). At the day 7 post-treatment visit, blood glucose remained significantly elevated compared to baseline in the 12 diabetic patients (13.9 ± 4.8 mmol/l versus 9.4 ± 3.3 mmol/l at baseline). In both the overall population and the various subgroups, plasma cortisol and ACTH and urinary free cortisol were markedly reduced at the day 1 and day 7 post-treatment visits, compared to baseline. At the day 21 visit, these variables were diminished in the group given epidural injections, whereas plasma cortisol and ACTH were normal in the group treated intra-articularly. No significant variations were noted for fasting blood glucose or for serum levels of cholesterol, triglycerides, sodium, and potassium.ConclusionThe administration of three local cortivazol injections was followed by suppression of the corticotropic axis that persisted beyond 21 days after epidural injection and recovered more rapidly after intra-articular injection. Systolic blood pressure increased transiently. Elevations in postprandial glucose levels lasted longer in diabetic than non-diabetic patients.     

Myasthenia gravis associated with HTLV-I infection and atypical brain lesions

We report a patient who experienced progressive diplopia and distal weakness of the upper limbs. Magnetic resonance imaging of the brain showed extensive white matter lesions and analysis of cerebrospinal fluid revealed acute human T-lymphotropic virus type I (HTLV-I) infection. Myasthenia gravis (MG) was evidenced by electromyography (EMG) and antibodies against acetylcholine receptor. This unusual case of MG associated with HTLV-I infection and brain-restricted lesions underscores the possible link between viruses and MG pathogenesis.