Diagnostic imaging of Tietze's syndrome. Comparison of computerized tomography and ultrasonography

Tietze's syndrome is an uncommon disease characterized by the absence of any systemic symptom; imaging techniques play a major role in the diagnosis of this condition. A control group including 10 normal subjects and 4 patients with clinical evidence of Tietze's syndrome were submitted to US; 3/4 patients underwent CT too. In the lesion site, US demonstrated thickened cartilage and inhomogeneously increased echogenicity in 4 patients, blurred outline in 3 patients and a hypoechoic halo in 1 patient. CT showed thickened cartilage and blurred outline in 3 patients and hypodense cartilage in 1 patient. Both methods were very useful to diagnose the disease in all cases. The authors conclude that US plays a major role in the diagnosis of Tietze's syndrome thanks to its harmlessness, repeatability and cost-effectiveness.     

Diagnostic imaging of benign and malignant liver tumors: computerized tomography or magnetic resonance tomography?

Diagnostic imaging, consisting of roentgenograms and magnetic resonance images (MRIs), was performed as part of an evaluation of the effects of a functional electrical stimulation (FES) program on the knee joints of 29 adolescents with spinal cord injuries following implantation of fine-wire intramuscular electrodes in their lower extremity muscles. The subjects underwent a regimen consisting of stimulated exercise, standing and/or walking. The effects of FES on knee joints were prospectively studied by reviewing diagnostic imaging data. Evaluation of MRIs and plain radiographs showed no evidence of knee joint pathology secondary to FES exercise or weight bearing. In fact, based on follow-up of MRI scan, many of the joints improved following participation in the program. The MRI data supported the clinical examination of the knee joints of these children. Clinical examination appears adequate for screening for potential knee joint problems.     

Liver injury in abdominal trauma. Review of the literature and personal observations

The association of infantile diarrhoea with the occurrence of Candida species and their different morphological cell forms (pseudohyphae and/or blastospores) in faeces was studied in children of 0-15 months in a developing community (Lahore, Pakistan) where malnutrition is prevalent. Stool samples from 119 patients admitted to the Diarrhoea Treatment Unit, Department of Pediatrics, King Edward Medical College, and 46 healthy children were investigated for yeasts, bacteria, viruses and parasites. Salmonella and enteropathogenic Escherichia coli were seen in 13 (11%) each of the cases while Candida was the most frequent micro-organism, grown in cultures from 38 (32%) of the diarrhoea cases. C. tropicalis dominated (19%) over C. albicans (6%) and C. parapsilosis (3%). However, in a great number of cases (23, equals 19%), Candida did not grow in cultures but blastospores and/or pseudohyphae were seen on microscopical examination. Other Candida species and yeasts were relatively more common in the control group. Candida albicans, C. tropicalis and C. parapsilosis were the only identified agents in 23 of the cases (19%). The characteristic clinical findings in children with Candida as the only identified pathogen were malnutrition (69%), age less than 8 months (90%), and microscopically identified pseudohyphae in faecal smears (71%).     

Drug therapy of hemiballism. Review of the literature and personal observations

Hemiballism is a rare hyperkinetic disorder which is characterized by irregular vigorous rotatory movements of the limbs of one side of the body. The disabling and exhausting movements with their high risk of severe injuries require an acute drug treatment. However, there are no common guidelines for the treatment of this disorder. Therefore we reviewed the available literature to establish a concept for a rational symptomatic drug treatment. Furthermore, own observations in 6 patients with hemiballism of different origins are reported.     

Giant pleomorphic adenoma of the parotid gland: case report and review of the literature

Pleomorphic adenomas account for the majority of parotid masses, typically arising in the tail of the gland and enlarging slowly over time. The vast majority are 2 to 6 cm in size when resected. We report resection of the largest benign mixed tumor recorded in the modern English language literature. An 85-year-old reclusive woman had a 20-year history of an enlarging right periauricular mass that had begun bleeding several days prior to admission. The patient ultimately underwent resection of the mass, which measured 26 cm in diameter, weighed 6.85 kg, and proved on pathologic examination to be a benign mixed tumor without malignant degeneration. The implications of this unusual case for the management of mixed tumors are discussed, and a review of the world literature on giant pleomorphic adenomas is presented.     

The ultrastructure of ependymoma: personal experience and the review of the literature

I report here the ultrastructure of 29 ependymal tumors. The ultrastructural pattern was florid and characteristic with a picture dominated by the presence of microlumina, cilia with basal bodies (blepharoplast), microvilli and long, interdigitating intercellular junctions of the zonulae adherentes (adhesive plaque junctions) type. Tumor cells themselves were not particularly peculiar but they formed typical patterns of rosettes (so called mini- or ultrastructural rosettes) cell gatherings around small, electron-lucent lumina which are filled with numerous microvilli. Empty microlumina were rare. The apical and lateral portions of the cells surrounding microlumina were sealed by intercellular junctions which are long, tortuous and clearly different from the zonulae occludentes (tight junctions) of epithelial tumors. Clusters of apparently "redundant" junctions were occasionally visible comprising segments of different lengths. Ependymoma cells contained myriads of 10 nm intermediate filaments (glial filaments), occasionally forming thick bundles, virtually identical to those encountered in astrocytic tumors and forming an ultrastructural correlate for the GFAP immunostaining. The glycogen granules were often remarkably numerous. Numerous cilia, with a typical 9+1 pattern or with a distorted pattern were frequently observed in longitudinal or cross-sections.     

The ultrastructure of oligodendroglioma: personal experience and the review of the literature

Five cases of stress fracture of the patella in athletes are presented. Four of these occurred transversally in the lower part and one longitudinally in the lateral part of the patella. Three of the patients were females (endurance runner, high jumper, and orienteerer) and two males (volleyball and soccer player). The diagnosis was made 2-8 months from the onset of the symptoms. Conservative treatment was successful in only one patient; all others were treated surgically, with good end result. Drilling of the fracture line was performed twice with metal wire cerclage fixation, excision of the lateral fragment was carried out once, and a bone graft with K wires and cerclage compression (tension band) was performed once. In all cases the patellar retinaculum was intact, indicating a stress injury. Stress fracture of the patella is a rare overuse injury, and therefore difficulties and delays in the diagnosis and treatment may occur. In cases with delayed diagnosis we recommend operative treatment.     

Diagnostic and therapeutic strategy of insulinomas. Apropos of a personal experience of 21 cases

Insulinomas account for about 90% of all pancreatic endocrine tumors and their surgical resection leads to cure in 90% of patients. Although current laboratory tests have simplified the clinical diagnosis of insulinomas, despite recourse to an array of most preoperative diagnostic procedures in 10-15% of patients the exact location of the tumor remains undefined. Tumor localization is difficult because: 80% of insulinomas measure less than 2 cm, about 10-12% of insulinomas are multicentric and 4-6% escape detection because are multiple endocrine neoplasms (MEN). If preoperative imaging fails to detect the site of the lesion, the surgeon could be obliged to perform a "blinded resection" with high risks of failure. The Authors refer their experience in a series of 21 patients operated on for insulinoma over the past 8 years (1987-1995). Arteriography with calcium stimulation (ASVS) and scintigraphy with 111-Indium-labeled octreotide performed in the later 16 and 13 cases respectively, achieved a correct tumor localization (confirmed by surgery) in 100% and 84.7% of patients. Intraoperative ultrasonography, performed in 18 cases, allowed not only to localize the tumor but also to study the tumor's neighbouring anatomic structures (Wirsung duct. splenic artery and vein), thus providing the anatomical and surgical information necessary to plan the right surgical strategy (tumor enucleation or pancreatic resection). Tumor enucleation was performed in 15 patients, distal pancreatic resections in 5 cases and multiple liver biopsies in 1 case: this patient had liver micrometastases from a malignant insulinoma without a palpable tumor. Operative mortality was nil. Postoperative complications occurred only in 5 of the 15 enucleations (1 pseudocyst successfully treated with a ultrasound-guided drainage and 4 pancreatic fistula resolved by medical therapy).     

The use of spiral computerized tomography in the study of pancreatic insulinoma: preliminary results

Insulinomas are usually benign tumors originating in the pancreatic islets: since they are biologically active tumors, insulinomas present at clinics with hypoglycemia caused by increased insulin production. We examined 7 patients with clinically suspected insulinomas with spiral CT to investigate its capabilities in identifying and characterizing this type of lesion. Four patients had abnormal spiral CT findings (true positives); the diagnosis was confirmed at surgery in 3 patients and at instrumental follow-up in the other. The tumors were 12.2 mm in average diameter. CT showed no tumor mass in 3 cases, which was confirmed at angiography and MRI (true negatives). We observed a typical contrast pattern in 50% of cases, namely a ring-like enhancement changing into homogeneous enhancement. Multiplanar and 3D reconstructions were not necessary for lesion identification, but we used them for regional vascular mapping. In our experience, which is limited to few cases and dose not allow any statistically significant conclusion, spiral CT exhibited high sensitivity in the detection and characterization of pancreatic insulinomas which permits to reduce the resort to more invasive angiographic techniques.     

Diagnostic tools for the detection of subclinical hepatic encephalopathy: comparison of standard and computerized psychometric tests with spectral-EEG

This study examined whether students' professional perceptions of interdisciplinary practice change following participation in a planned interdisciplinary experience in the rural setting, relative to their own profession and other health related disciplines. Data were collected from students enrolled in varied academic programs who participated in planned interdisciplinary experiences in the care of patients while in the clinical area through the Idaho Rural Interdisciplinary Training Project. Repeated measures multivariate and univariate analysis of variance revealed a significant change in students' perceptions of professional competence and autonomy of other disciplines and their own following the interdisciplinary experience in the clinical area. The data also revealed a significant change in students' perceptions at the completion of their clinical rotation of actual cooperation and resource sharing within and across professions. There was a significant gender effect and pretest to post-test effect following the interdisciplinary experience in the rural setting.     

1,5 Tesla MRI in focal nodular hyperplasia. Review of the literature apropos of 7 cases

There are increasing reports of unusual clinical features and atypical courses of syphilis in patients with acquired immunodeficiency syndrome. Recently, we had the opportunity to study an HIV-positive female patient with strong manifestations of secondary syphilis. The case is discussed together with the implications of secondary syphilis in her concomitant ocular affliction. Moreover, we comment on the clinico-therapeutic controversies brought about by the association of infection with Treponema pallidum and HIV.     

Physical parameters in the use of MRI tomography. Limitation due to physiologic reactions and guidelines. Radiation Protection Commission

PURPOSE: The standards and regulations concerning the protection of patients and operator staff within the context of MRI are compiled. Resulting consequences regarding physical parameters are evaluated. MATERIAL AND METHODS: The static magnetic field, heating effects caused by RF-fields and acoustical noise are outlined. The actual boundaries of these parameters are compared against the relevant published standards. Peripheral stimulation limits due to pulsed gradient fields have been determined in a new clinical study. RESULTS: Many parameters recommended for the normal operating mode are already exceeded during routine MRI. Referring to our clinical study, we found that limits recommended in the MRI relevant standards are unnecessarily conservative and can actually be doubled. CONCLUSIONS: The applicable national and international standards and regulations show (at least partly) that serious differences in the definition of terms and values exist. The application of these standards would be much easier if they were made uniform. The values defined in the MR-specific standards should be adapted to actual knowledge concerning patients' safety.     

The assessment of fracture of the mandibular condyle by use of computerized tomography. Incidence of sagittal split fracture

A survey was carried out to clarify the incidence of sagittal splitting fracture of the mandibular condyle using computerized tomography. There were 33 patients, between 11 and 67 years of age, with displaced or dislocated mandibular condylar process fractures (41 cases), seen at our clinic between 1986 and 1992. The incidence of no displacement was 4.9%; deviation and displacement, 34.1%; dislocation, 46.3%; and complete avulsion, 4.9%. A sagittal splitting fracture of condyle occurred with an incidence of 9.8%. Conservative treatment was effective in the treatment of sagittal splitting fracture. Therefore, classification of fracture of mandibular condyle should include the sagittal split fracture, and investigations should include computerized tomography.     

Clinical use of nitric oxide inhalation. Review of the literature and initial clinical experiences

The authors review published data devoted to a new trend in intensive care of pulmonary hypertension: therapy of right ventricular heart failure and gas exchange disorders caused by impaired ventilation-perfusion relationship by inhalation of nitrogen oxide (NO). Mechanisms of NO effect, its metabolism, method of application and safety regulations, and doses and efficacy in various clinical situations (pulmonary hypertension in heart diseases, transplantations of the heart and lungs, respiratory distress syndrome, persistent pulmonary hypertension of the newborns) are analyzed. The first clinical experience gained by the authors demonstrated a favorable effect of NO therapy on the central hemodynamics in patients with acquired valvular defects and patients subjected to orthotopic transplantations of the heart. Approaches to research and pathogenetic validation of NO therapy are outlined.     

Computed tomography in schizophrenic patients. Results from 15 patients. Review of the literature (author's transl)

The authors analyzed the scans of 15 chronic schizophrenic patients, apparently deteriorated, all of whom were long standing in-patients. They found 11 pathological cases (6 cortical atrophies and ventricular enlargement, 3 ventricular enlargement, 1 cortical atrophy, 1 cerebellar atrophy). With one exception all these atrophies were slight. The authors findings are comparable with those already reported in other studies. The article also summarizes the results of earlier studies of schizophrenics, by pneumoencephalography which are similar. Although no firm conclusions can be drawn, for such a limited sample, in particular due to the lack of any visible correlation between the pictures obtained and clinical diagnosis or prognosis, the consistent appearance of tomographic anomalies justifies continued research on these lines.     

Comparisons of pulmonary and sinonasal lesions in patients with cystic fibrosis. Evaluation using computerized tomography

INTRODUCTION: Cystic fibrosis is a recessive genetic systemic exocrinopathy caused by a variety of mutations in the cystic fibrosis transmembrane conductance regulator gene (CFTR). The disease is characterized by alterations of the secretions, which become thickened and viscous. Both the paranasal sinuses and the lung parenchyma are involved in all cases. The aim of this study was to assess a correlation between the rhinosinusal and lung parenchyma changes in cystic fibrosis patients. MATERIAL AND METHODS: Eighteen patients (11 men and 7 women, age range: 8 to 22 years) were examined with chest HRCT and sinonasal low dose CT. Lung symptoms were found in all patients; 13 of them, also affected with rhinosinusal symptoms, had been examined with ENT and nasal endoscopy. The other 5 patients, without rhinosinusal symptoms and previously examined with ENT, were evaluated as control group. Chest CT was performed with the high-resolution technique, 2 mm slice thickness and 10 mm table feed. Rhinosinusal CT was performed with the low dose technique, acquiring contiguous 2-4 mm thickness coronal sections. The CT patterns were analyzed by two radiologists and scored as slight, medium and diffuse involvement of both districts. RESULTS: No statistically significant correlation between lung and sinonasal damage was found in our study. Parenchymal lung involvement appeared more severe than sinonasal involvement in 14/18 patients. The retention of secretions in the paranasal sinuses, even if limited, was demonstrated in all symptomatic and asymptomatic patients. CONCLUSIONS: The absence of correlation between pulmonary and sinonasal damage and more generally, the different severity of cystic fibrosis can be caused by different allele mutations of the cystic fibrosis transmembrane conductance regulator gene, the most frequent of which is Delta F-508.     

Counseling and psychotherapy with Asian-Americans: Review of the literature.

Reviews the existing literature on counseling and psychotherapy with Asian-Americans and discusses research needs and recommendations for future research. Diagnosis and assessment issues include symptom expression, therapist bias, problems with the use of interpreters, and problems with the use of clinical and personality tests. Client variables in counseling and psychotherapy involve the personality of Asian-Americans, language problems, the acculturation process, and counseling expectations. Therapist variables involve therapist bias, training bias, lack of intercultural skills, and culture-specific knowledge. In a discussion of process and outcome, the author reviews empirical studies, clinical case studies, and articles with treatment strategies and recommendations. Research recommendations for each of the areas reviewed are identified. (3 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Combined radiochemotherapy for organ preservation in head and neck cancer: review of literature and personal experience

Combined radiochemotherapy is the most common method aimed at improving the rate of clinical response in advanced head and neck cancer. Complete clinical remission may correspond to a significant percentage in organ and/or function preservation. In 1992 a protocol of concomitant radiochemotherapy with continuous infusion of carboplatin for 14 consecutive days at the daily dose of 30 mg/m2 and concomitant radiotherapy with conventional fractionation (1.8 Gy to a total 65-70Gy) was started. Over a 3-year period, 56 patients with advanced head and neck cancer, were treated. In view of organ preservation, 26 patients of this series, though with considerable extent of the disease at diagnosis, were considered candidates for radical surgery: oral cavity 9 patients; oropharynx 9 patients; larynx/hypopharynx 8 patients. A single patient was stage I (hypopharynx); most patients were stage III (7) and IV (17 = 65%); T4 20%, N3 23%. 17/20 patients (70%) showed complete clinical response, 6 partial clinical response with a single non responder (overall response 95%). A patient underwent total glossectomy followed by local recurrence and another patient underwent pharyngolaryngectomy also followed by recurrence. After a mean follow-up from 22 to 60 months, 9 patients were still free of disease (37.5%). Median duration of complete response was 25.6 months. Overall median survival was 26.7 months: 38 months in responders. 2-year survival of patients with complete response was 59%. As for organ preservation, at present 6 over 18 patients (33%) with tumor of the oral cavity or oropharynx and 3 patients with tumors of larynx/hypopharynx have preserved organ and function. As for complete responders, 54.5% of those with tumors of oral cavity or oropharynx and 50% of those with tumors of larynx/hypopharynx, have preserved anatomy and function after at least 2-year follow-up. To-date, in follow-up controls relevant late toxicity has not been observed, showing that to the positive anatomical result corresponds the functional preservation of single structures.     

Synovial sarcoma of the parotid gland. A case report with clinicopathological analysis and review of the literature

Primary sarcomas of the major salivary glands are exceptionally uncommon. Synovial sarcoma is a distinctive neoplasm which usually arises in the extremities in the region of joints. Although synovial sarcomas arising in the head and neck region are well described, tumours actually originating in and around the major salivary glands are exceedingly rare, with few cases reported in the literature. We report a synovial sarcoma in the right parotid gland of a 67-year-old man. The literature pertaining to salivary gland sarcomas and synovial sarcoma of the head and neck region is reviewed.