Intratemporal vascular tumors: detection with CT and MR imaging

The diagnostic contributions of computed tomography (CT) and magnetic resonance (MR) imaging were compared in 12 patients with benign intratemporal vascular tumors (hemangioma or vascular malformation). The tumors included six in the internal acoustic canal and six in the geniculate ganglion region. Clinical and histologic correlations were made. Two of the six patients with tumors in the internal acoustic canal underwent CT, and both required gas cisternography to show the tumor. Five patients in that group underwent MR imaging, and all five studies showed the tumor. All six patients with geniculate ganglion tumors underwent CT. Results in one study were questionable, and five showed the tumor. Five patients in this group underwent MR imaging, but the MR findings were positive in only two cases. MR imaging should therefore be performed before CT in the evaluation of facial nerve dysfunction, as it demonstrated all tumors in the internal acoustic canal and some in the geniculate ganglion region. If MR findings are negative, CT should then be performed to rule out a possible geniculate ganglion lesion.     

Severe erythroblastopenia and hemolytic anemia during a hepatitis A infection

A 41-year-old woman had acute hepatitis A infection complicated with severe anemia due to selective erythroblastopenia and hemolysis. A mechanism involving a cellular immune reaction is suggested. The hematological complications resolved during steroid treatment. She later developed a transient seropositive arthritis.     

Ptosis surgery: shortening the levator aponeurosis of Müller's muscle and the tarsus using an anterior approach

In cases of moderate congenital ptosis, better lid elevation can be achieved by resection of the levator muscle through a skin incision, combined with tarsectomy and shortening of the superior tarsal muscle. The function of the levator muscle can thus be fully exploited.     

Mecillinam susceptibility as an indicator of β-lactamase production in Staphylococcus aureus

The use of direct susceptibility testing from specimens has led to the fortuitous observation that penicillin-susceptible strains have larger inhibition zones for mecillinam than do β -lactamase producers. The current study was, therefore, undertaken to test 179 Staphylococcus aureus isolates for mecillinam susceptibility by Rosco Neo-Sensitabs and to compare the results with commonly used tests for β -lactamase production, i.e. size and character of penicillin inhibition zones, chromogenic cephalosporin (nitrocefin) tests and clover leaf assays. Agreement between methods was reached for 175 of 179 strains when disregarding the results of the nitrocefin tests, 88 isolates being found susceptible and 87 being found to be β -lactamase producers. All 88 susceptible isolates had mecillinam zones of >22 mm, with the great majority being >25 mm; double zones did, however, occur. The 87 β -lactamase producers had zones <14 mm or no zones. Four isolates presenting problems in had mecillinam zones of ≤20 mm and were without tapering growth at the penicillin inhibition zone edge. In conclusion, the size of the mecillinam inhibition zone is found to be a useful supplementary test in the clinically important distinction between β -lactamase-producing and non-producing isolates of S. aureus .     

Acute peripheral arterial and graft occlusion: treatment with selective infusion of urokinase and lysyl plasminogen

Thirty-five patients hospitalized for recent angiographically documented arterial occlusion in the legs (27 femoropopliteal arteries and eight grafts) benefited from local fibrinolytic therapy delivered at the site of the occlusion with a 4- or 5-F catheter. This therapy combined a continuous urokinase (UK) infusion of 1,000 U/kg/hour and a lysyl plasminogen (LYS-PLG) infusion of 15 microkatals every 30 minutes. Angiographically confirmed lysis was obtained in 85% of the cases. Only 3% of the patients had major and 6% had minor groin hematomas. Only two patients had concentrations of fibrinogen as low as 100 mg/dl. Intravascular infusion of UK-LYS-PLG is as effective as streptokinase. Its excellent tolerance makes it a good alternative in the treatment of acute ischemia in the lower limbs.     

High prevalence of Clostridium difficile diarrhoea during intensive chemotherapy for disseminated germ cell cancer.

A prospective, consecutive study of the aetiology of treatment-associated diarrhoea was conducted in 25 patients with disseminated germ cell cancer treated with intensive chemotherapy. Clostridium difficile was isolated in 45% of the diarrhoea episodes, which makes this species the most important bacterial pathogen in the development of clinically significant diarrhoea in this group of immunocompromised patients.     

Temporal disparity in pineal and retinal ontogeny

The development of photoreceptors and two putative neurotransmitter systems in the pineal organ and retina was studied during embryogenesis in the three-spined stickleback Gasterosteus aculeatus L. The investigation was performed by aid of immunocytochemistry using well characterized antisera to the retinal proteins alpha-transducin (TD alpha) and S-antigen (SA) (photoreceptor-markers), antisera against L-glutamic acid decarboxylase (GAD), gamma-aminobutyric acid (GABA), choline-O-acetyltransferase (ChAT) and with acetylcholinesterase (AChE) histochemistry (neurotransmitter-markers). It was possible to set up the following developmental time-table concerning the first appearance of positive immuno- and enzyme-reactive cells in the pineal organ and retina: I AChE-activity and TD alpha- and SA-immunoreactive cells in the pineal organ; II GAD- and GABA-immunoreactive cells in the pineal organ and retina; ChAT immunoreactivity and AChE activity in the retina; III hatching; IV SA-immunoreactive cells in the retina. The obtained results provide good evidence that while photoreceptor cells develop much earlier in the pineal organ than in the retina, neurons develop simultaneously in the pineal organ and retina.     

The chronic fatigue syndrome – an update

Background –  In this article, current scientific knowledge on the chronic fatigue syndrome (CFS) is reviewed. The US case definition of CFS (the CDC-definition) is most widespread in research and clinical practice. Estimates of prevalence vary from 0.2% to above 2%. The female–male ratio is approximately 3:1.
Clinical Features –  Severe fatigue is the dominating complaint; it is worsened from exertions and not substantially relieved by rest. In addition, the patients might have a varying combination of accompanying symptoms. Clinical evaluation should be based upon standardized guidelines, including an assessment of functional impairments.
Pathophysiology –  The pathophysiology should be interpreted within a biopsychosocial framework. Present knowledge suggests that certain genetic polymorphisms and personality traits might be regarded as predisposing factors, some infections and severe psychosocial stress constitute precipitating factors, whereas disturbances of immunity, skeletal muscle, cognitive abilities, endocrine control and cardiovascular homeostasis are possible perpetuating factors.
Treatment –  Cognitive behavioural therapy and graded exercise therapy are of proven value in randomized controlled trials. Several pharmaceutical measures have been explored and found to have no beneficial effect. Most patients might expect long-term improvement, but full recovery is rare; however, the prognosis is better among adolescents.