Pontine metastases as a cause of dysphagia in lung carcinoma

Dysphagia is an unusual symptom in the clinical course of lung carcinoma. When it appears, it is necessary to differentiate between regional dissemination, drug toxicity, opportunistic infection and, most rarely, metastatic dissemination to the brain stem. Magnetic resonance imaging (MRI) is the best diagnostic option to exclude this last possibility. We present a male patient with progressive dysphagia 15 months after the diagnosis of an oat-cell lung carcinoma. Cerebral MRI revealed a pontine lesion, probably of metastatic origin.     

Effects of ketanserin of left ventricular hypertrophy in hypertensive patients

Summary Ketanserin, a serotonergic S₂-receptor antagonist, was used in a prospective study in nine hypertensive patients with ECG criteria of left ventricular hypertrophy (LVH). Echocardiographic measurement with M mode was made after 1 month of placebo, and after 3, 6, and 12 months of ketanserin treatment as monotherapy at a mean dose of 31 mg bid. Ketanserin treatment decreased mean left ventricular mass by 9.3% at 3 months (not significant), by 15.3% at 6 months (p < 0.008), and by 26.2% at 12 months (p < 0.02), with a tendency towards improvement in left ventricular ejection fraction, which was not statistically significant. The study showed a sustained effect upon regression of LVH in hypertensives, with preservation of left ventricular function.     

Angiocentric lymphomas of the palate: clinico-pathological considerations in 12 cases

Angiocentric lymphomas (AL) involving the mid-face are infrequent lesions. Their incidence seems to be higher in certain Asian and Latin American countries, where most of the reported series reveal a predominance of T-cell lineage and a high frequency of EBV-positive cells. The clinical and pathological features of 12 AL that affected the palate are presented. Immunophenotypic studies were performed in nine of these cases. Seven (77%) demonstrated T-cell lineage, one was of B-cell origin and one could not be classified. The high incidence of T-cell lesions in this and other studies supports the existence of geographical and possibly of etiological differences in these neoplasms.     

Human islet isolation and allotransplantation in 22 consecutive cases.

This report provides our initial experience in islet isolation and intrahepatic allotransplantation in 21 patients. In group 1, 10 patients underwent combined liver-islet allotransplantation following upper-abdominal exenteration for cancer. In group 2, 4 patients received a combined liver-islet allograft for cirrhosis and diabetes. One patients had plasma C-peptide greater than 3 pM and was therefore excluded from analysis. In group 3, 7 patients received 8 combined cadaveric kidney-islet grafts (one retransplant) for end-stage renal disease secondary to type 1 diabetes mellitus. The islets were separated by a modification of the automated method for human islet isolation and the preparation were infused into the portal vein. Immunosuppression was with FK506 (group 1) plus steroids (groups 2 and 3). Six patients in group 1 did not require insulin treatment for 5 to greater than 16 months. In groups 2 and 3 none of the patients became insulin-independent, although decreased insulin requirement and stabilization of diabetes were observed. Our results indicate that rejection is still a major factor limiting the clinical application of islet transplantation in patients with type 1 diabetes mellitus, although other factors such as steroid treatment may contribute to deteriorate islet engraftment and/or function.     

Lesions Confined to the Sphenoid Ridge: Differential Diagnosis and Surgical Treatment

Tumors confined to the sphenoid ridge with little or no extradiploic extension are very rare; we describe here five patients with these lesions. Three were females and two males, with an average age of 33.4 years; the clinical presentation included proptosis and facial deformity. The diagnoses were three meningiomas (one “en plaque,” one globous, and one intraosseous) and two fibrous dysplasias (compact form). Although the radiological findings were similar, we could find some details to establish the differential diagnosis before the surgical procedure. All the lesions were totally removed without complications. In a follow-up period of 15 to 36 months none of the lesions has shown clinical or radiological evidence of recurrence. We discuss the pathophysiology of each case, and propose the pterional orbito-zygomatic approach as the best way to resect lesions in this location.     

Favorable responses to acute and chronic exercise in McArdle patients.

OBJECTIVE: This study reports acute exercise responses in a large (N = 46) series of patients with McArdle disease and responses to exercise training in a smaller (n = 9) set of patients. DESIGN: Patients were studied during both incremental and steady-state cycle ergometer exercise, using cardiopulmonary testing, and the patients were compared with age- and gender-matched controls. SETTING: The study was performed in a university setting (clinical exercise physiology laboratory). PARTICIPANTS: The 46 patients showed common features of McArdle disease. They were definitively diagnosed by histochemistry, biochemistry, and/or molecular genetic analysis. The 46 controls were healthy, sedentary individuals. INTERVENTION: Nine patients were studied before and after an 8-month supervised aerobic exercise training program (including five weekly sessions of walking and/or cycling exercise with a duration no greater than 60 minutes). MAIN OUTCOME MEASUREMENTS: The main indicators of exercise capacity that we measured were peak power output, peak oxygen uptake (VO2peak), and ventilatory threshold (VT). RESULTS: Exercise capacity (peak power output, 35% control; VO2peak, 44% control; VT, 66% control) was markedly depressed in the patients. The patients who trained improved peak power output (25%), VO2peak (44%), and VT (27%), with no evidence of negative outcomes from training. Although not achieving normal values, the response to training put the patients into the lower limit of normal controls. CONCLUSIONS: Under carefully controlled conditions, patients with McArdle disease may perform acute exercise safely, and they may respond favorably to training. This may offer an additional therapeutic option to help normalize the lifestyles of these patients.     

Symptomatic simple cysts of the liver: treatment by laparoscopic surgery

Summary This report describes the case of a 73-year-old patient who presented with symptomatic uncomplicated liver cysts. Treatment of this case by laparoscopic surgery is described and a short review of the literature is presented.     

Examining the evidence in anesthesia literature: a survey and evaluation of obstetrical postdural puncture headache reports

PURPOSE: To describe a bibliographic database on the literature of postdural puncture headache (PDPH) in the obstetrical population, to describe the research architecture in this field, and to evaluate the quality of case-control studies, cohort studies, and controlled clinical trials on PDPH. METHODS: Computerized bibliographic searches, citation review, and hand searches were conducted to find all relevant citations on incidence, clinical course, prevention, or treatment of PDPH in parturients. The study design and topic(s) covered by each study were evaluated. Case-control studies and cohort studies were evaluated using the Quality Index; clinical trials were evaluated using the Jadad scale. RESULTS: One hundred ninety-six relevant citations were published between 1949 and 1999. Research on PDPH has been increasing rapidly with the majority of studies published in the 1990's. Incidence and prevention were the focus of over half of all citations. Optimal study designs were infrequently utilized. The methodological quality was poor for observational studies (Quality Index 10/29) and clinical trials (Jadad scale 2/5). CONCLUSION: Although the amount of research on PDPH in parturients is increasing, use of optimal study designs and improvement in methodology is needed.     

Nosocomial septicaemias in a cardiologic ward

Nosocomial septicaemias were studied in a cardiologic ward at the University Hospital of Antwerp, Belgium. The incidence of nosocomial infections was found to be 2.7 per 1,000 admissions per year. A case-control study suggested that in contrast with coronarography and pacemaker implantation, percutaneous transluminal coronary angioplasty may be a risk factor for nosocomial septicaemia (OR 4.5, 95% confidence interval 0.7–33.4).