MR imaging of cerebral toxoplasmosis: correlation of computed tomography and pathology

A case of cerebral toxoplasmosis in a patient with acquired immune deficiency syndrome who was evaluated by both CT and magnetic resonance is reported. Magnetic resonance proved to be far more sensitive in detecting the intracranial lesions than CT.     

The forearm flap as a free neurovascular flap for treatment of an extensive bone/soft-tissue defect in the calcaneal part of the foot

A discussion is presented on the case of a 28-year-old motorcyclist who had an accident and got caught in the spoked wheel of her vehicle. The result was an extensive soft-tissue injury of the metatarsus and calcaneal part of the foot, a defect fracture of the calcaneus, an osseous disinsertion of the Achilles tendon, a lateral malleolus Weber type-A fracture, and a fracture of the second metatarsal bone. The primary treatment consisted in extensive débridement of the strongly contaminated soft parts and refixation of the Achilles tendon on the calcaneus with two osteosynthesis screws. The bruised skin flaps remaining were adapted in a tension-free manner. However, this was possible only in a considerable talipes equinus position. In the further course, the patient developed an extensive skin and soft-tissue necrosis over the calcaneal part of the foot. A neurovascularly pedicled forearm flap was freely grafted in order to maintain the load capacity of the calcaneal part of the foot, to prevent osteitis of the calcaneus, to correct the talipes eqinus position, and to achieve a resensibilization in the load zone of the sole. The healing result was good, and it was possible to achieve extensive correction of the talipes equinus position as well as prevention of calcaneus osteitis; the function of the Achilles tendon was also maintained. Moreover, there was satisfactory resensibilization of the calcaneal part of the foot, so that the patient can now walk in ready-made shoes with a fully molded arch support.     

Transfer of group B streptococci from mothers to neonates: effect of whole body washing of mothers with chlorhexidine

Seven babies born to 28 mothers who were vaginal carriers of group B streptococci and who bathed or showered with chlorhexidine during the last 2 weeks of pregnancy were colonized with an organism of the same phage type as their mothers. In contrast, nine babies of 14 carrier mothers who were given no instructions regarding washing were colonized with the same phage type as their mothers. Ten of the 84 sites sampled for group B streptococci on the babies born to mothers using chlorhexidine were positive, whereas 17 of 42 were positive in the babies born to control mothers. This trial suggests that whole body washing with chlorhexidine may reduce the transfer of group B streptococci from mothers to infants, but did not exclude the possibility that body washing by itself may have a similar effect.     

Doppler-guided cannulation of the internal jugular vein: A prospective,randomized trial

Objectives. The internal jugular vein (IJ) is commonly used as an access to the central venous system. Despite the high success rate for cannulation of the IJ, the incidence of complications (1% to 16%) has remained essentially the same, with most complications resulting from unintentional punctures of surrounding structures. In an attempt to reduce the complication rate of this technique, we evaluated the use of a Doppler-guided needle device to cannulate the IJ.Methods. The study was performed on 41 patients scheduled for cardiothoracic or major vascular surgery requiring central vein cannulation as part of their anesthetic management.Results. The number of needle advances in the Doppler group was 1.35 (SD 0.88) compared with 2.8 (SD 2.78) in the control group (p = 0.037). A significantly greater percentage of cannulations were successful on the first attempt in the Doppler group (85%), compared with the control group (55%) (95% CI for proportion = 0.3 to 0.57).Conclusion. The Dopplerguided cannulation technique can reduce the number of attempts required for successful IJ cannulation.     

Photodynamic therapy of oesophageal cancer

Twenty-three patients, 12 males and 11 females aged 42–86 years (mean age 69.6), with inoperable oesophageal cancer were treated by endoscopic photodynamic therapy. Inoperability in 20 patients was due to extent of tumour and existence of metastases, in two because of poor general condition and in one patient due to recurrence at the site of previous anastomosis. Prior to treatment, patients' degree of dysphagia and their functional status were recorded. Using barium contrast studies and endoscopy, the extent and location of the tumour within the lumen of the oesophagus were mapped out. Treatment protocol consisted of intravenous administration of the photosensitizer, Polyhaematoporphyrin, followed 24–48 h later by illumination of the tumour with 630 nm light produced by a copper vapour pumped-dye laser and delivered via a 400m internal diameter optical fibre with a cylindrical diffusing end. All treatments were undertaken under general anaesthesia as day case procedures. There was no treatment-related mortality nor was there any complication apart from a mild skin photosensitivity reaction in one case. Every patient's swallowing and functional status was improved at 6 weeks post-treatment. Ten patients needed more than one treatment: five required oesophageal dilatation. Thirteen patients survived a mean period of 6.2 months. Two needed oesophageal intubation 3–4 weeks before their death. Ten patients are alive at 6–14 months. This study suggests photodynamic therapy in inoperable oesophageal cancer to be a useful treatment method and in suitable cases an alternative to other forms of palliation. Its value lies in the fact that it can be used to treat cancer at any level of the oesophagus irrespective of histology.     

Cervical intraextradural hematoma secondary to radicular artery injury: a case report

A young man presented with a 5-year history of high cervical pain after a blunt blow to the neck and clinical evidence of myelopathy. Preoperative radiographic findings, including metrizamide myelography, CT scan, and vertebral angiography, were consistent with a right C2-3 "dumbell" shaped intradural-extradural tumor. At surgery a firm red-grey mass was found beneath an abnormally thin right C2-3 facet joint. This mass was both intradural and extradural and extended laterally through the root canal to merge with an area of dense adhesions surrounding the vertebral artery. Pathological examination showed no tumor and was consistent with chronic, organized hematoma. Aspects of this unique case of intradural-extradural hematoma in the distribution of a radicular vessel, and possible etiologic considerations are discussed.     

Glutathione S-transferase T1 and M1 genotypes in normal mucosa, transitional mucosa and colorectal adenocarcinoma

Gene codings for glutathione S-transferase T1 (GSTT1) and M1 (GSTM1) are polymorphic in humans with null genotypes present in approximately 20 and 50%, respectively. A significant excess of homozygous null GSTT1 and GSTM1 genotypes has been demonstrated among individuals with certain types of cancers. This finding suggests that GSTT1 and GSTM1 may play a role in tumour susceptibility. However, reports concerning colorectal cancer susceptibility are controversial. In the present study, we used a multiplex polymerase chain reaction (PCR) approach to identify and analyze simultaneously the genotypes of both the genes in 99 patients with colorectal cancer and 109 healthy controls. Compared with the control group, a significant excess of homozygous null genotypes for GSTT1 was found in normal mucosa among the cancer patients, but not for GSTM1. Both genes were more frequently deleted in tumours than in corresponding normal mucosa. Furthermore, GSTT1 null genotype in tumour tissue, was significantly related to old age and to poor differentiation of tumours. GSTM1 null genotype in tumour was more frequent in the rectal tumours compared with tumours of left colon and right colon. Our results suggest that individuals with GSTT1 null genotype may be genetically predisposed for an increased risk of developing colorectal cancer. Allele loss in tumour tissue, which reflects genetic instability, may be considered as a marker for evaluating clinico-pathological characteristics of the cancer patients.