An Abdominal Aortic Aneurysm in an 8-Month-Old Girl with Tuberous Sclerosis

The association between an abdominal aortic aneurysm (AAA) and tuberous sclerosis (TS) is rare. An 8-month-old girl presented with a seizure, and the clinical evaluation revealed TS. An abdominal evaluation showed a 3-cm infrarenal AAA. A normal diameter of infrarenal aorta for an 8-month-old girl is about 6 mm. The patient underwent an open repair with a polytetrafluoroethylene (PTFE) prosthesis. The pathology showed a loss of elastin fibres in the media of the aorta. The graft was patent on computed tomography (CT) angiography, performed 4 months after the operation. However, the patient died of complications related to seizures 5 years after the surgery. The graft remained patent until the time of death.     

A Case of Disseminated Nocardiosis Secondary to the Skin Nodules in an Elderly Woman

Nocardiosis refers to a locally invasive or disseminated infection associated with the Nocardia species. Most infections enter through the respiratory tract and then disseminate systemically. Rarely can a primary nocardial infection of the skin spread to contiguous structures or disseminate to other internal organs in immunocompromised hosts. We describe a 70-year-old woman who suffered from recurrent nodular skin lesions on her right hand, forearm and elbow following inoculation of a traumatic injury. Analysis of the purulent exudates obtained from the nodule revealed Nocardia species. After 20 days, a chest X-ray showed newly developed multiple nodules in both lungs. The diagnosis of systemic nocardiosis was established, and we treated this case with trimethoprim-sulfamethoxazole.     

Acute toxicity of all‐trans‐retinoic acid loaded poly(L‐lactide)/poly(ethylene glycol)‐poly(L‐lactide) microspheres in mice

Previously, poly(L‐lactide) microspheres containing retinoic acid (RA) had been prepared for parenteral administration in order to overcome “acute retinoic acid resistance.” In this study, acute toxicities of RA‐loaded microspheres were investigated in mice after the microspheres were injected intramuscularly. The maximum dose of RA in the microspheres was determined by considering both the injection volume and dispersion of microspheres in the vehicle media, and the dose levels were determined to be 0, 90, 180, and 360 mg RA/kg. Mice were carefully observed for any clinical signs for 14 days, and gross observation of the organs was performed at 14 days. When a dose of 90 mg RA/kg was administered, no severe toxicities were observed; however, with the administration of 180 and 360 mg RA/kg, abnormal appearances of organs, such as discolor, atrophy, hemorrhage, etc., were observed. There were no mortalities or bone fractures observed at any of the doses. In our previous study of cancer treatment using the RA‐loaded microspheres, the growth of head and neck carcinoma in athymic nude mice was successfully inhibited at the dose of 100 mg RA/kg. It was concluded that a dose of approximately 90 mg RA/kg of the RA‐loaded microspheres would be most desirable for cancer therapy. Drug Dev. Res. 57:134–139, 2002. © 2002 Wiley‐Liss, Inc.     

Shear bond strength of dental amalgam bonded to dentin

The objective of this study was to determine the shear bond strength of dental amalgam bonded to dentin with adhesives. Four groups of 15 permanent posterior teeth were used in this study. The occlusal enamel of the teeth was removed to produce a flat dentin surface. The teeth were embedded in phenolic rings with acrylic resin. Vinyl polysiloxane ring molds 4 mm thick with 4.5 mm circular openings were attached to the exposed dentin surface. Adhesives applied to the dentin surfaces prior to amalgam placement and condensation included: Amalgambond, a 4-META/TBB-MMA, HEMA based system (A), Panavia EX, a modified phosphate ester of Bis-GMA luting system (P), and Ketac-Cem, a glass ionomer luting cement (K). A dentin bonding agent and composite resin restoration system (Scotchbond 2/Silux Plus) was included for comparison. The specimens were stored in 37 degrees C water for 7 days prior to testing. Shear bond tests were done in an Instron machine at a crosshead speed of 0.02 inches per minute. The data were analyzed by ANOVA at 5% level of significance. The differences in shear bond strengths of the four test groups were not statistically significant (P = 0.115). Fracture patterns of the bonded amalgams, examined by SEM, were adhesive in appearance for Groups A and K and cohesive for Group P.     

Prospective comparison of novel dark blood late gadolinium enhancement with conventional bright blood imaging for the detection of scar

Background

Conventional bright blood late gadolinium enhancement (bright blood LGE) imaging is a routine cardiovascular magnetic resonance (CMR) technique offering excellent contrast between areas of LGE and normal myocardium. However, contrast between LGE and blood is frequently poor. Dark blood LGE (DB LGE) employs an inversion recovery T2 preparation to suppress the blood pool, thereby increasing the contrast between the endocardium and blood. The objective of this study is to compare the diagnostic utility of a novel DB phase sensitive inversion recovery (PSIR) LGE CMR sequence to standard bright blood PSIR LGE.

Methods

One hundred seventy-two patients referred for clinical CMR were scanned. A full left ventricle short axis stack was performed using both techniques, varying which was performed first in a 1:1 ratio. Two experienced observers analyzed all bright blood LGE and DB LGE stacks, which were randomized and anonymized. A scoring system was devised to quantify the presence and extent of gadolinium enhancement and the confidence with which the diagnosis could be made.

Results

A total of 2752 LV segments were analyzed. There was very good inter-observer correlation for quantifying LGE. DB LGE analysis found 41.5% more segments that exhibited hyperenhancement in comparison to bright blood LGE (248/2752 segments (9.0%) positive for LGE with bright blood; 351/2752 segments (12.8%) positive for LGE with DB; p?<?0.05). DB LGE also allowed observers to be more confident when diagnosing LGE (bright blood LGE high confidence in 154/248 regions (62.1%); DB LGE in 275/324 (84.9%) regions (p?<?0.05)). Eighteen patients with no bright blood LGE were found to have had DB LGE, 15 of whom had no known history of myocardial infarction.

Conclusions

DB LGE significantly increases LGE detection compared to standard bright blood LGE. It also increases observer confidence, particularly for subendocardial LGE, which may have important clinical implications.

     

Brazilian Intragastric Balloon Consensus Statement (BIBC): practical guidelines based on experience of over 40,000 cases

Background

Intragastric balloons (IGBs) are a minimally invasive option for obesity treatment, acting as a space-occupying device and leading to weight loss through increased satiety. This device has been growing in popularity owing to its safety profile and good weight loss results. However, there are no published guidelines that standardize the technical aspects of the procedure.

Sonography of Fat Necrosis Involving the Extremity and Torso With Magnetic Resonance Imaging and Histologic Correlation

Objective. The purpose of this study was to describe the sonographic appearance of pathologically proven isolated fat necrosis involving the extremities or torso with magnetic resonance imaging (MRI) correlation. Methods. A query of the Department of Pathology database at our institution for the diagnosis of fat necrosis resulted in 1539 cases. Review of the cases and medical records excluded cases without sonographic imaging, those involving the breast, and those within or adjacent to a primary process, including masses or prior surgery, which resulted in a total of 5 cases of primary fat necrosis, 2 of which were evaluated with MRI. Sonograms were reviewed by 2 musculoskeletal radiologists and characterized with regard to location, echogenicity, shadowing, posterior through‐transmission, a hypoechoic rim or halo, definition of borders, homogeneity, a mass effect, and vascularity. The patient medical records, histologic results, and MRI findings were also reviewed. Results. Of the 5 cases of isolated fat necrosis, 2 involved the torso and 3 the lower extremities. On sonography, all were located in the subcutaneous fat; 2 were isoechoic; 3 were hyperechoic; 2 had a hypoechoic halo; none showed shadowing or posterior through‐transmission; 2 were well defined; 3 were masslike; 4 were heterogeneous; and 2 showed increased flow on color or power Doppler imaging. Magnetic resonance imaging showed an intermediate signal and either diffuse or ring enhancement. Conclusions. Isolated fat necrosis of the extremities and torso had 2 sonographic appearances, which included a well‐defined isoechoic mass with a hypoechoic halo and a poorly defined hyperechoic region in the subcutaneous fat.