Recognition and treatment of rabbit syndrome, an uncommon complication of neuroleptic therapies

Rabbit syndrome is an uncommon, tongue-sparing, orofacial movement disturbance, rapid and regular in nature and associated with prolonged use of neuroleptics. Two cases reports illustrate how anticholinergic agents successfully treat the disorder. The syndrome is distinguished from tardive dyskinesia, which tends to be exacerbated by anticholinergic agents.     

Orientation of the manubrium mallei: inexplicably widely variable

BACKGROUND: There is no consensus why the manubrium of the malleus, as viewed clinically through the external ear canal, generally points downward and posteriorly. OBJECTIVES: To depict the alignment of the handle of the malleus, viewed clinically through the external auditory canal, relative to the zygomatic arch, the Frankfort plane, and a visual plane proxy and relative to the horizontal semicircular canal. Also, to assess bilateral symmetry and manubrium alignment relative to mastoid pneumatization. STUDY DESIGN: Postmortem anatomic dissection of 41 bequeathed adult crania without clinical otitis. METHODS: The line of the manubrium as viewed through the external ear canal was measured relative to the Frankfort plane, to a proxy of the visual plane, and to the zygomatic arch. Mastoid sizes were determined radiographically. In a subset of 10 crania additionally studied by computed tomography, the manubrium position was checked relative to the horizontal semicircular canal. RESULTS: Relative to the zygomatic arch and Frankfort and visual planes, the range of manubrium angles was at least 45 degrees. Bilateral symmetry was found, each r 0.38 or greater (P < .05). Relative to the horizontal canals, the range of manubrial angles was 30 degrees, with symmetry suggested. Alignment did not correlate with mastoid pneumatization. CONCLUSION: Manubrium orientation as viewed through the external auditory canal is not obviously explicable. The wide variety of manubrium orientations may explain the manubrium-stapes offset that perplexes manubrium-stapes surgical constructions.     

Metastatic breast cancer of the oral cavity

OBJECTIVE: To present a rare case of breast carcinoma initially presenting as an oral cavity mass. STUDY DESIGN: Case report with review of the literature. RESULTS: A case is presented of a postmenopausal woman with a remote history of treated breast carcinoma who was declared disease-free 2 years before presentation. She presented with an enlarging vestibule mass consistent with metastatic breast carcinoma. Subsequent investigations revealed widely metastatic disease for which the patient was referred for palliative chemotherapy. CONCLUSIONS: Metastatic disease to the oral cavity represents only 1% of all oral cavity malignancies. A high index of clinical suspicion is necessary when evaluating patients with a history of non-head and neck carcinoma.     

Fungal rhinosinusitis: state-of-the-art diagnosis and treatment

The past 30 years has been witness to a period of tremendous growth and innovation within the field of rhinology, facilitating a better understanding and improved management techniques for a variety of local and systemic conditions manifesting within the nose and paranasal sinuses. Of these disease states, the spectrum of conditions considered under the rubric of fungal rhinosinusitis best exemplifies modern rhinology's position as a truly multidisciplinary specialty. We review the classification of the various forms of fungal rhinosinusitis and their clinical presentations, radiologic findings, and treatment options.     

Larger deficits in brain networks for response inhibition than for visual selective attention in attention deficit hyperactivity disorder (ADHD)

BACKGROUND: Brain activation differences between 12 control and 12 attention deficit hyperactivity disorder (ADHD) children (9- to 12-year-olds) were examined on two cognitive tasks during functional magnetic resonance imaging (fMRI). METHOD: Visual selective attention was measured with the visual search of a conjunction target (red triangle) in a field of distracters and response inhibition was measured with a go/no-go task. RESULTS: There were limited group differences in the selective attention task, with control children showing significantly greater intensity of activation in a small area of the superior parietal lobule region of interest. There were large group differences in the response inhibition task, with control children showing significantly greater intensity of activation in fronto-striatal regions of interest including the inferior, middle, superior and medial frontal gyri as well as the caudate nucleus and globus pallidus. CONCLUSION: The widespread hypoactivity for the ADHD children on the go/no-go task is consistent with the hypothesis that response inhibition is a specific deficit in attention deficit hyperactivity disorder.