HCC masquerading as gluteal mass: A rare presentation

Hepatocellular carcinoma (HCC) is the most common primary tumor of the liver. Extrahepatic metastasis occurs mostly through the hematogenous route and is seen in around one-third of patients with the common sites of involvement being the lungs, regional lymph nodes, bone, adrenal glands, and pancreas. Soft-tissue metastasis from HCC is an extremely rare condition. Here, we present a rare case of an elderly male, with HCC presenting as a soft-tissue mass in the gluteal region. We further provide a detailed discussion regarding the investigative approach used to arrive at the diagnosis and the treatment modalities offered. Case reports like this may offer insight into the possibilities of such unusual presentations and aid the clinician in his endeavor to the early diagnose and treat the patient.

Tofo gotoso en dorso nasal: reporte de caso / Nasal gouty tophus: case report

La gota es el trastorno del metabolismo de las purinas que se caracteriza por acumulación de ácido úrico por aumento de su producción o por disminución de su excreción. Con el paso del tiempo, el exceso de urato monosódico permite que se deposite en diferentes tejidos del organismo; siendo particularmente infrecuente la presentación de tofos a nivel facial. Paciente masculino adulto de 56 años, con antecedente de gota hace 38 años y presencia de tofos gotosos a nivel de miembros superiores e inferiores que acude por cuadro de 4 años de evolución de lesión indurada, levemente dolorosa a nivel de tercio medio de dorso nasal que ha ido aumentando de tamaño, que causa deformidad de pirámide nasal y leve sensación de obstrucción nasal bilateral por lo que se planifica resolución quirúrgica. El análisis histopatológico de las muestras enviadas bajo exéresis quirúrgica confirma que tejido enviado corresponde a tofo gotoso. Los tofos gotosos pueden aparecer en diferentes tejidos, como cartílagos, membranas y líquido sinovial, superficies articulares, siendo excepcionalmente raro, en el miocardio, válvulas mitral y aórtica, ojos, nariz y médula espinal. El lugar de presentación puede ser muy variable, al igual que su tamaño

Gout is a purine metabolism disorder characterized by accumulation of uric acid due to increased production or decreased excretion. Over time, excess monosodium urate allows it to be accumulated in different body tissues, although the occurrence in the facial area is particularly infrequent. A 56- year-old male patient with a gout antecedent from 38 years ago that presented gouty tophi at the level of the upper and lower limbs seek medical advice due to an indurated slightly painful lesion at the level of the middle third of the nasal dorsum that started 4 years before and has been increasing in size. The lesion was causing nasal pyramid deformity and a slight sensation of bilateral nasal obstruction, for which surgical resolution is planned. The histopathological analysis of the samples sent under surgical exeresis confirms that the tissue sample corresponds to gouty tophi. Gouty tophi can appear in different tissues, such as cartilage, membranes and synovial fluid, joint surfaces, being exceptionally rare in the myocardium, mitral and aortic valves, eyes, nose and spinal cord. The place of presentation can be very variable, as well as its size

An unusual nasopharyngeal foreign body with unusual presentation

Upper aerodigestive tract may harbour foreign bodies such as sponges, grains, toy parts, stones, paper, insects, cotton, glass ball, etc. These objects may go undetected for days or even weeks. A metallic foreign body after being inhaled and ultimately being lodged in the nasopharynx is a rare entity. We report a case of an unusual nasopharyngeal foreign body (glass ball) presenting with symptoms of nasal regurgitation and change in voice in a 2-year boy. The foreign body was diagnosed by X-ray skull lateral view including nasopharynx and was removed under general anesthesia.

Mannheimia varigena as the etiologic agent of lameness and coronary band lesion in cattle / Mannheimia varigena como agente etiológico de claudicação e lesão na banda coronária em bovinos

Mannheimia varigena was identified as the etiologic agent of lameness and coronary band lesion in 30% of cattle in a farm located in Rio Grande do Sul, Brazil. Swab samples from the lesions were cultured in McConkey Agar and Blood Agar for microbiological identification. Culture growth was submitted to Gram staining and Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) identification. Antimicrobial susceptibility test based on disc diffusion was performed for three antibiotics: ceftiofur, gentamicin and florfenicol. Furthermore, molecular characterization of 16S rDNA gene sequencing was performed and the data was used in a phylogenetic analysis. For that purpose, total DNA was extracted by thermo extraction directly from the bacterial colonies and the polymerase chain reaction (PCR) was performed. Gram-negative Mannheimia varigena strain LBV010/22 was identified as the causative of the lesions. The strain was susceptible to all antibiotics tested. The phylogenetic analysis demonstrated that the analyzed strain is closely related to M. varigena strains from pyelonephritis and respiratory tract. Overall, this is the first report of M. varigena as the causative agent of coronary band injury in bovine. Therefore, our findings show the importance of an accurate microbiological identification of infectious agent in lameness cases in order to prevent the occurrence and perform an appropriate treatment in the future.

Mannheimia varigena foi identificada como agente etiológico de claudicação e lesão de banda coronária em 30% dos bovinos de uma fazenda localizada no Rio Grande do Sul, Brasil. Amostras de swab das lesões foram cultivadas em Ágar McConkey e Ágar Sangue para identificação microbiológica. O crescimento da cultura foi submetido à coloração de Gram e identificação por Espectrometria de Massa de Ionização por Dessorção a Laser Assistida por Matriz (MALDI-TOF MS). O teste de suscetibilidade antimicrobiana baseado na difusão em disco foi realizado para três antibióticos: ceftiofur, gentamicina e florfenicol. Além disso, foi realizada a caracterização molecular do sequenciamento do gene 16S rDNA e o resultado utilizado para análise filogenética. Para tanto, o DNA total foi extraído por termoextração diretamente das colônias bacterianas e uma reação em cadeia da polimerase (PCR) foi realizada. Foi identificada como causadora das lesões a cepa gram-negativa de Mannheimia varigenaLBV010/22. Ela foi suscetível a todos os antibióticos testados. A análise filogenética demonstrou que a cepa analisada está intimamente relacionada às M. varigena presentes em pielonefrite e no trato respiratório. No geral, este é o primeiro relato de M. varigenacomo agente causador de lesão de banda coronária em bovinos. Portanto, nossos achados mostram a importância de uma identificação microbiológica precisa do agente infeccioso nos casos de claudicação, a fim de prevenir a ocorrência e realizar um tratamento adequado no futuro.

Complicated grief, unusual perceptual experiences, and hope in widowhood / Luto complicado, experiências perceptivas incomuns e esperança na viuvez / Duelo complicado, experiencias perceptuales inusuales y esperanza en la viudez

The overall objective of this study is to assess grief in religious widows and hope, and the frequency of unusual perceptual experiences after the death of the spouse. It is hypothesized that (H1) religious widows will experience a less complicated grief, (H2) a greater hope, and (H3) a higher frequency of unusual perceptual experiences than non-religious widows. Three instruments, the Complicated Grief Inventory, the Hope Scale, and the Hallucinations Questionnaire were administered to a sample consisting of religious widows and a control group (non-religious widows). The results showed that religious widows experienced less complicated grief than non-religious widows, and fewer feelings of pessimism about the death of the loved one. Religious widows who showed higher feelings of hope, compared to non-religious ones, tended to have fewer indicators of complicated grief. Furthermore, those religious widows who displayed feelings associated with remembering the deceased tended, for example, to hear voices and smell perfumes. It is possible that these occurrences may even be functional and adaptive in order to cope with the negative feelings of grief and loss, rather than resulting in a resource deficit mechanism for dealing with pain and hopelessness.

O objetivo geral deste estudo é avaliar o luto e a esperança em viúvas religiosas, e a frequência de experiências perceptivas incomuns após a morte do cônjuge. A hipótese é que (H1) viúvas religiosas experimentarão um luto menos complicado, (H2) mais esperança e (H3) maior frequência de experiências perceptivas incomuns do que viúvas não religiosas. Três instrumentos, o Inventário do Luto Complicado, a Escala de Esperança e o Questionário de Alucinações, foram administrados a uma amostra composta por viúvas religiosas e um grupo de controle (viúvas não religiosas). Os resultados mostraram que as viúvas religiosas experimentaram um luto menos complicado do que as viúvas não religiosas e menos sentimentos de pessimismo em relação à morte de um ente querido. As viúvas religiosas que mostraram maior senso de esperança, em comparação com as viúvas não religiosas, tendem a ter menos indicadores de luto complicado. Além disso, aquelas viúvas religiosas que demonstravam sentimentos associados à memória do falecido tendiam, por exemplo, a ouvir vozes e cheirar perfumes. É possível que essas ocorrências possam até ser funcionais e adaptativas para lidar com os sentimentos negativos de luto e perda, em vez de ser um mecanismo de déficit de recursos para lidar com a dor e a desesperança.

El objetivo general de este estudio es evaluar el duelo en viudas religiosas y la esperanza, y la frecuencia de experiencias perceptuales inusuales después de la muerte del cónyuge. Se hipotetiza que (H1) las viudas religiosas experimentarán menor grado de duelo complicado, (H2) mayor esperanza y (H3) mayor frecuencia de experiencias perceptuales inusuales que las viudas no religiosas. Se administraron tres instrumentos, el Inventario de Duelo Complicado, la Escala de Esperanza, y el Cuestionario de Alucinaciones a una muestra integrada por viudas religiosas y un grupo control (viudas no religiosas). Los resultados mostraron que las viudas religiosas experimentaban menos duelo complicado que las viudas no religiosas, y menos sentimientos de pesimismo en torno a la muerte del ser querido. Las viudas religiosas que mostraron mayor sentimiento de esperanza, en comparación con las no religiosas, tendieron a menos indicadores de duelo complicado. Además, aquellas viudas religiosas que mostraban sentimientos asociados al recuerdo del difunto tendían, por ejemplo, a oír voces y oler perfumes. Es posible que estas ocurrencias puedan incluso ser funcionales y adaptativas para afrontar los sentimientos negativos del duelo y la pérdida, en lugar de resultar un mecanismo de déficit de recursos para lidiar contra el dolor y la desesperanza.

Erratic migration of Ascaridia hermaphrodita (Nematoda: Ascaridida) in a blue-fronted Amazon parrot (Amazona aestiva) from illegal wildlife trade: case report / [Migração errática de Ascaridia hermaphrodita (Nematoda: Ascaridida) em papagaio-verdadeiro (Amazona aestiva) oriundo do comércio ilegal: relato de caso]

Ascaridiasis by Ascaridia hermaphrodita is a common parasitic disease in blue-fronted Amazon parrots (Amazona aestiva) and the contamination occurs by ingestion of eggs. Illegal trade of wild birds can increase the frequency of visceral erratic migration by this parasite. Hence, this report describes the erratic migration of A. hermaphrodita and associated lesions in a blue-fronted Amazon parrot. This is a retrospective study, which originated from several apprehension of illegal birds in the state of Paraíba, Brazil. Necropsy revealed intense intestinal ascarid infestation. Hepatic lesions were also observed associated with the parasite migration. Stereoscopy allowed the identification of the morphology of the parasites. Summarizing, this condition in wild birds is not fully understood and may be associated with illegal trade.(AU)

Ascaridíase por Ascaridia hermaphrodita é uma doença parasitária comum em papagaios-verdadeiros. Sua contaminação ocorre pela ingestão de ovos. O tráfico de aves silvestres pode facilitar a migração errática visceral desse parasita. Este relato descreve a migração errática de A. hermaphrodita e lesões associadas em papagaio-verdadeiro. Trata-se de um relato retrospectivo, analisado a partir de uma série de apreensões de aves no estado da Paraíba, Brasil. A necropsia revelou intensa infestação ascarídea intestinal. Também foram observadas lesões hepáticas em uma ave, associadas à migração do parasita. A estereoscopia permitiu distinguir a morfologia dos parasitas. Resumidamente, essa condição em aves silvestres é pouco conhecida e pode ser considerada, inclusive, associada à comercialização ilegal.(AU)

Unusual presentation of moyamoya disease with popliteal involvement: case report and review of the literature / Apresentação incomum de doença de moyamoya com envolvimento poplíteo: relato de caso e revisão da literatura

Abstract Moyamoya disease is a rare disorder that involves the cerebrovascular system. Usually, it leads to occlusion of the arteries of the cerebral system and causes cerebral circulatory complaints. A 48-year-old female patient was admitted to our clinic with intermittent claudication in both legs. Biphasic and monophasic waveform patterns were detected bilaterally in distal (trifurcation arteries) lower extremities with Doppler sonography. The patient therefore underwent systemic vascular examination. Computed tomography angiography revealed bilateral carotid occlusion at the level of supraclinoid segments, and opacifications were detected at the distal segments of the bilateral anterior cerebellar and middle cerebellar arteries. The patient was diagnosed with moyamoya disease, and anticoagulant treatment was started. In conclusion, most previous reports have presented the cerebrovascular involvement of moyamoya disease. However, this disease can involve different peripheral vascular systems and careful and systemic vascular examination is necessary for an exact diagnosis.

Resumo A doença de moyamoya é um distúrbio raro que envolve o sistema cerebrovascular. Normalmente, leva à oclusão das artérias do sistema cerebral e causa problemas circulatórios no cérebro. Uma mulher de 48 anos foi admitida em nossa clínica com claudicação intermitente em ambas as pernas. Na ultrassonografia com Doppler, foram detectados padrões de formato de onda bifásico e monofásico nas extremidades inferiores distais (artérias da trifurcação) de forma bilateral. Portanto, realizou-se o exame vascular sistêmico na paciente. A angiografia por tomografia computadorizada revelou oclusão carotídea bilateral no nível dos segmentos supraclinoides, e opacificações foram detectadas nos segmentos distais das artérias cerebelares anteriores e médias de forma bilateral. A paciente foi diagnosticada com doença de moyamoya, e o tratamento anticoagulante foi iniciado. Em conclusão, a maioria dos relatos anteriores apresentou o envolvimento cerebrovascular da doença de moyamoya. No entanto, essa doença pode envolver diferentes sistemas vasculares periféricos, e um exame vascular sistêmico minucioso é necessário para um diagnóstico exato.

Unusual presentation of patent ductus arteriosus in elderly patient

Abstract We presented a case of a 56-year-old man with giant pulmonary artery aneurysm caused by a misdiagnosed patent ductus arteriosus, severe multivalvular disease and active aortic valve endocarditis successfully treated by surgery. The correct diagnosis was missed despite preoperative diagnostics because the small patent ductus arteriosus was located at the distal part of common pulmonary trunk and a huge regurgitant signal overlapped its Doppler signal. Thorough evaluation of every patient, regardless of age, is necessary to recognize and treat this congenital anomaly.

An unusual presentation of acute gastric volvulus in the elderly patient: a case report and literature review

Gastric volvulus is nothing but the torsion of stomach in thoracic cavity by more than 1800 along its transverse or longitudinal axis. A very rare case occurring both in male and female. The term first described by Berti after doing an autopsy of a female, in 1886. We found a case of 65 years old male with history of dyspepsia since, 1 year with history of vomiting and pain abdomen since, 1 day. On evaluation, clinically gurgling sound heard on left side chest and with investigations like USG and CT whole abdomen, we came to know about mesentrico axial volvulus which is more common in children. Acute gastric volvulus cases have high mortality rate also requires emergency surgery. Gastric volvulus is very rare with variable and non-specific clinical presentations, hence high level of suspicion for radiologic diagnosis may require. Acute gastric volvulus is a potentially life-threatening occurrence with a good outcome when treated in a timely fashion. Chronic volvulus may be more difficult to recognize. Timely diagnosis with proper treatment can potentially decreases morbidity and mortality of the patient.

An unusual giant schwannoma over face diagnosed on FNAC: a case report

Schwannoma is a slow growing benign peripheral nerve sheath tumor arising from schwann cells. It is also known as neurilemmoma. Although it is common in the head and neck region, it rarely exceeds 10 cm in size. Usually Schwannomas are notlarger than 5 to 6 cm in diameter.Large tumors are uncommon and are found in posterior mediastinum or retroperitoneum. We are presenting an unusual giant cell schwannoma over face (cheek) measuring 12×10cmsin size which caused facial deformity to the patient. The tumor was diagnosed on FNAC where cell block was prepared and IHC was done which showed S-100 positivity. This size schwannomaover cheek site has not been reported in the literature as far our knowledge. Therefore this case is unique for its size over face.

Fracturas inusuales de la diáfisis del fémur por bifosfonatos. Reporte de caso clínico / Unusual fractures of the femoral shaft produced by bisphosphonates use. Case report

Existe una tendencia actual de presentación de fracturas de fémur atípicas en la población adulta. El tratamiento con bifosfonatos durante más de 5años puede poner a los pacientes en mayor riesgo. El objetivo del reporte es mostrar como con un dispositivo intramedular rígido puede mantenerse la posición y la longitud del fémur y a su vez mejorar la inestabilidad y el dolor en fracturas no desplazadas secundarias al uso de bifosfonatos. Se revisó el caso clínico de una paciente de 77años con cuadro clínico de 2meses de evolución de dolor moderado presente con la deambulación y que mejora en reposo. Se realizaron exámenes imagenológicos y se planificó la colocación del dispositivo intramedular rígido. Posteriormente se realizó una valoración clínica mediante la escala funcional de miembro inferior y se realizaron radiografías de control para determinar el grado de consolidación durante el tratamiento y la supresión del alendronato. Se realizó fijación con clavo intramedular gamma de segunda generación citando a control periódicamente a la paciente y suprimiendo la terapia con alendronato. A los 6meses de postoperatorio se aplicó la escala funcional de miembro inferior, obteniendo un resultado del 100%.

There is a growing trend of atypical femur fractures in the current adult population. Treatment with bisphosphonates for more than 5years may put patients at greater risk. The aim of this report is to demonstrate how surgical treatment with a rigid intramedullary device can maintain the position and length of the femur by improving stability and pain in non-displaced fractures secondary to the use of bisphosphonates. A review is presented on the clinical case of a 77year-old patient with moderate pain on walking of 2-months onset that improved with rest. After imaging tests were performed, it was decided to insert a rigid intramedullary device. The subsequent follow-up included a clinical assessment using the Lower Extremity Functional Scale (LEFS). Control X-rays were performed to determine the degree of consolidation during treatment, as well as the suspending of alendronate. Fixation was made with a second-generation gamma intramedullary nail, after which there was periodic monitoring and suspension of alendronate therapy. At 6months post-operatively, the LEFS was applied, obtaining a 100% result.

Artroplastia total de rodilla con defecto angular extraarticular. Reporte de caso / Total knee arthroplasty with extra-articular angular deformity. Case report

Establecer cuales deformidades angulares en el fémur deben ser tratadas con resección ósea intraarticular inusual más artroplastia total de rodilla en artrosis tricompartimental de rodilla es uno de los retos mayores que se enfrenta en cirugía ortopédica. Presentamos el caso de un paciente masculino de 67 años de edad, con antecedente de fractura diafisaria de fémur hace 30 años tratada en forma conservadora con dolor en la rodilla izquierda de 2 años de evolución con un diagnóstico de artrosis tricompartimental de la rodilla asociada a genu valgum de 20° y consolidación viciosa en diáfisis femoral izquierda con valgo femoral de 10°. El tratamiento quirúrgico realizado fue utilizando cortes intraarticulares inusuales y artroplastia total de rodilla. De acuerdo a la escala propuesta por la Knee Society Score el paciente obtuvo 89 al año de la cirugía. Ante deformidades femorales de hasta 20°, suele ser suficiente realizar la corrección con los cortes óseos intraarticulares (inusuales) evitando afectar las inserciones ligamentarias femorales.

To establish the angular deformities in the femur that should be treated with unusual intra-articular bone resection plus total knee arthroplasty in tricompartmental arthrosis of the knee is one of the major challenges faced in orthopaedic surgery. The case is presented of a 67 year-old male patient with a history of diaphyseal fracture of the left femur (30 years ago) treated conservatively with malunion in left femoral diaphysis with 10° femoral valgus and left knee pain of 2 years onset. He was diagnosed with tricompartmental osteoarthritis of the knee associated with genu valgum of 20°. Surgical treatment was performed using intra articular «unusual¼ bone cuts and total knee arthroplasty. According to the scale proposed by the Knee Society Score, the patient obtained a score of 89 one year after surgery. In femoral deformities of up to 20°, it is usually sufficient to perform the correction with intra articular «unusual¼ bone cuts, and avoiding affecting the femoral ligament insertions.

Metástasis de carcinoma diferenciado de tiroides en localizaciones infrecuentes: serie de 30 pacientes / Unusual metastases from differentiated thyroid carcinoma: series of 30 patients and review of literature

RESUMEN Introducción Las metástasis son la principal causa de mortalidad específica en carcinoma diferenciado de tiroides (CDT). Las localizaciones más frecuentes son el pulmón y el hueso. El compromiso de otros sitios es inusual. Se desconoce el impacto que tienen en la evolución y sobrevida de los pacientes. Objetivos Evaluar la prevalencia de metástasis infrecuentes (MI) en pacientes con CDT, sus características clínico-patológicas y el impacto en la mortalidad. Material y métodos: Estudio multicéntrico retrospectivo. Se incluyeron pacientes con CDT y MI (diferentes de pulmón y hueso). Se analizaron las características basales, las localizaciones de las MI, el subtipo histológico, el tiempo de aparición desde el diagnóstico inicial (sincrónicas o metacrónicas), sintomatología asociada. Resultados La localización más frecuente fue el sistema nervioso central (31%). El 76,6% fueron metacrónicas, y presentaron criterios de refractariedad al yodo en 76,6% de los casos. La mitad de los pacientes presentó síntomas específicos. En 73,28% de los casos implicaron cambios en la conducta terapéutica. 19 pacientes (63,3%) fallecieron a causa de la enfermedad, con una mediana de sobrevida desde el diagnóstico de la MI de 11 meses. La sobrevida fue menor en pacientes con MI yodorefractarias y sintomáticas. Conclusiones: Las MI tuvieron una prevalencia baja, y se presentaron en forma metacrónica. Determinaron cambios en la estrategia terapéutica y se relacionaron con la mortalidad específica en más de la mitad de los casos, lo que resalta la importancia de una estadificación precisa en pacientes con enfermedad avanzada.

ABSTRACT Introduction Complications related to metastatic disease are the main cause of specific mortality in differentiated thyroid cancer (DTC.) The most common sites of metastses are lung and bone. Other localizations are infrequent and they have been reported as isolated cases or small series. The impact of unusual metastases (UM) in patient management and prognosis remains largely unknown. Objectives To retrospectively evaluate the prevalence of UM in DTC patients, define their clinical-pathological characteristics and analyze its relevance in management and mortality. Patients and methods: We retrospectively reviewed file records from 7 databases. DTC patients who had metastatic disease in sites different from lung or bone were included. UM were diagnosed by: i) biopsy and/or ii) radioiodine (RAI) bone uptake + elevated thyroglobulin (Tg) levels and/or c) bone uptake of 18-FDG in the PET-CT scan + elevated Tg levels. We analyzed histopathologic characteristics, clinical presentation, localization, time of diagnosis (synchronic vs. metachronic presentation), diagnostic and therapeutic modalities and final outcome of patients. Results UM were diagnosed in 30 out of 2986 DTC patients (1%). The most common site of UM was the central nervous system (CNS 31%). Twenty percent of the patients had more than one UM. In 93% of the cases, UM coexisted with either lung and/or bone metastases and/or locoregional disease. Papillary histology was found in 75% of cases; 76.6% were metachronic with DTC diagnosis, and 76.6% fulfilled radioiodine refractoriness criteria. Half of the patients reported symptoms related to the UM. In 73.2% of the cases, therapeutic decisions were influenced by the diagnosis of the UM. Nineteen patients (63.3%) died of DTC related causes, with a mean survival of 11 months. The most frequent cause of death was CNS progression. Survival was shorter in patients with radioiodine refractory and symptomatic lesions. Conclusions Prevalence of UM was low; they were predominantly metachronic and iodine refractory. UM were found in patients with widespread disease, however, treatment strategies were modified by their diagnosis. UM were associated with poor survival and disease specific mortality.

Sesgo atribucional en pacientes psiquiátricos, religiosos y un grupo control en el juicio de la experiencia alucinatoria: la tarea del White Christmas test / Attributional Biases in Psychiatric Patients, a Religious, and a Control Group in the Assessment of a Hallucinatory Experience: The "White Christmas Test"

RESUMEN El objetivo de este estudio es evaluar la experiencia alucinatoria auditiva en una muestra clínica de pacientes con historial psiquiátrico (p. ej., esquizofrénicos), practicantes religiosos (p. ej., cristianos evangélicos devotos) y un grupo control (sin trastorno mental y no religiosos devotos). La muestra estuvo integrada por individuos de ambos sexos. La muestra de pacientes se reclutó en 2 hospitales psiquiátricos de la Ciudad Autónoma de Buenos Aires, un grupo de practicantes religiosos (cristianos devotos) en un culto evangélico y un grupo de control no religioso y carente de síntomas psiquiátricos previos. Se aplicó el Cuestionario de Experiencias Alucinatorias y el Oxford-Liverpool Inventory Feelings and Experiences, y luego se administró el White Christmas Test, que evalúa el grado de la imaginería auditiva vívida con base en una versión del paradigma de detección de serial, en que el sujeto cree escuchar un tema musical en el trasfondo de un ruido blanco. Los pacientes mostraron mayor sesgo atribucional que los evangélicos y el grupo control, pero además los religiosos también tendieron a mostrar mayor sesgo (aunque en menor grado) que el grupo control. Además, los pacientes tendieron a mostrar más esquizotipia y experiencias alucinatorias que los evangélicos y el grupo control, pero sorprendentemente el grupo control mostró mayor esquizotipia negativa que el grupo religioso, lo cual indica que las prácticas religiosas podrían contribuir a disminuir los efectos negativos de la esquizotipia.

ABSTRACT The aim of this study was to evaluate the auditory hallucinatory experience in a clinical sample of patients with psychiatric symptoms (e.g. Schizophrenia), a religious group (eg. Christians) and a "control" group (with no mental disorder and non-religious). The sample consisted of individuals of both sexes. The patient sample was recruited in two psychiatric hospitals of Buenos Aires City, the religious from an evangelical cult, and people with no religious beliefs or previous psychiatric symptoms (control group). The Hallucinatory Experiences Questionnaire and the Oxford-Liverpool Inventory Feelings and Experiences were the measurement tools used. The White Christmas Test was also administered in order to assess the degree of vivid imagery hearing based on a version of signal detection paradigm in which the subjects think that they hear a song in the background of white noise. The results showed that patients showed greater attributional bias (compared with evangelicals and the control group), but the religious group also tended to show greater bias (although less) than the control group. In addition, patients tended to show greater schizotypal and hallucinatory experiences compared with the evangelicals and the control group, but surprisingly, the control group showed higher negative schizotypy than the religious group, which indicates that religious practices could help reduce the negative effects of schizotypy.

Analysis of unusual movement in 164 cases of brain death organ donors / 中华器官移植杂志

Objective By analyzing unusual movements of brain death organ donors before organ donation,to avoid misunderstanding and ensure the implementation of organ donation successfully.Methods Relevant clinical data of potential brain death organ donors admitted to the First Affiliated Hospital of Sun yat-sen University were prospectively collected between January 2016 and December 2017.The related parameters of neurological examination,neuroimaging examination and laboratory examination after brain death determination were dynamically recorded.The occurrence of limb,head and respiratory-like movement after brain death was defined as unusual movements,and the factors associated with unusual movements were screened by univariate and multivariate analysis.Results According to the inclusion criteria,164 patients were enrolled into this study.Twenty-two (13.4％) had unusual movements and duration was less than 72 h.Among them,21 (12.8％) had limbs unusual movements,6 (3.7％) had respiratory-like movement,5 (3％) owned both,and 4 (2.4％) had head rotation accompanied with limbs unusual movements.Univariate and multivariate analysis showed that axillary temperature ≤36 ℃,serum sodium ≤125 mmol/L,primary brain stem injury,spontaneous respiratory arrest time ≤72 h and age ≤ 18 years were associated with unusual movements.Conclusion During the clinical practice of brain death determination in China,the incidence of unusual movements is relatively low,and related to some factors,but it is extremely easy to cause misunderstanding.Correct cognition and interpretation are contributed to the successful implementation of organ donation.

The Extended Examination

@#The mind may be examined by using reflective communication which is also known as active listening. We pay attention to the modes, phases and channels of communication; the purposeful use of unusual grammar forms; and we also create discrepancies to destabilize the patient’s mind to get past his conscious mind and seek a deeper unguarded response from him or her. In the reflective communication, we validate, track and pace the patient’s thoughts, emotions and behavior. We express affirmation, empathy and sympathy and connection with the patient by use of mirroring, modelling and metaphors. Reflective communication skillfully used, helps the doctor to examine and understand the patient’s mind, and it also helps the patient to gain insight to his problem.

Cáncer epidermoide en piel cabelluda, presentación inusual. Reporte un caso / Epidermoid cancer on scalp, an unusual presentation. A case report

Resumen Se presenta el caso clínico de una paciente de 47 años de edad, la cual cursó con una lesión en piel cabelluda de gran dimensión (10 X 10 cm de diámetro) de un año de evolución. Se realizó estudio histopatológico, que reportó cáncer epidermoide moderadamente diferenciado. La tomografia de cráneo mostró tumoración de piel cabelluda que erosiona el cráneo. Fue tratada en servicio de oncología médica y servicio de radioterapia para reducción de masa tumoral, radioterapia y 5 ciclos de cisplatino más docetaxel. Al existir respuesta favorable, se interviene quirúrgicamente con rotación de colgajos y colocación de injerto. El estudio histopatológico postratamiento reportó: carcinoma epidermoide moderadamente diferenciado, permeación vascular que infiltra dermis y tejido subcutáneo; fragmento óseo sin datos de neoplasia viable. Se continuó manejo con capecitabina como mantenimiento. La paciente falleció 5 años después del diagnóstico con metástasis pulmonares. El objetivo de la presentación de este caso es resaltar que el cáncer de piel puede presentarse de forma inusual y en pacientes con factores de riesgo poco frecuentes, como en este caso. La sospecha clínica oportuna conducirá al establecimiento del diagnóstico y tratamiento adecuados.

Abstract This is a case report of a female patient of 47 years of age. She presented a large scalp injury, 10 cm wide, with a year of evolution. The histopathological study reported a moderately differentiated squamous cell carcinoma and the tomography showed a scalp tumor eroding the skull. She was treated at the medical oncology services and radiation therapy services for debulking, radiotherapy and 5 cycles of cisplatin plus docetaxel. If the response is favorable, a surgical intervention will be performed with rotation flaps and a graft placement. The post-treatment histopathological study reported: a moderately differentiated epidermoid carcinoma, vascular permeation infiltrating dermis and subcutaneous tissue and bone fragments with no viable neoplasm data. Capecitabine was prescribed as maintenance. The patient died 5 years after the diagnosis because of pulmonary metastases. The aim of this case report is to make emphasis in the fact that skin cancer can occur in unusual ways and in patients with rare risk factors like this case. Timely clinical suspicion may lead to a favorable diagnosis and treatment.

A wearable system for adaptation to left–right reversed audition tested in combination with magnetoencephalography

Exposure of humans to unusual spaces is effective to observe the adaptive strategy for an environment. Though adaptation to such spaces has been typically tested with vision, little has been examined about adaptation to left–right reversed audition, partially due to the apparatus for adaptation. Thus, it is unclear if the adaptive effects reach early auditory processing. Here, we constructed a left–right reversed stereophonic system using only wearable devices and asked two participants to wear it for 4 weeks. Every week, the magnetoencephalographic responses were measured under the selective reaction time task, where they immediately distinguished between sounds delivered to either the left or the right ear with the index finger on the compatible or incompatible side. The constructed system showed high performance in sound localization and achieved gradual reduction of a feeling of strangeness. The N1m intensities for the response-compatible sounds tended to be larger than those for the response-incompatible sounds until the third week but decreased on the fourth week, which correlated with the initially shorter and longer reaction times for the compatible and incompatible conditions, respectively. In the second week, disruption of the auditory-motor connectivity was observed with the largest N1m intensities and the longest reaction times, irrespective of compatibility. In conclusion, we successfully produced a high-quality space of left–right reversed audition using our system. The results suggest that a 4-week exposure to the reversed audition causes optimization of the auditory-motor coordination according to the new rule, which eventually results in the modulation of early auditory processing.

Acute Non-Fulminant Viral Hepatitis E Presenting with Acute Pancreatitis—An Unusual Presentation

Acute pancreatitis is considered to be an extremely rare extrahepatic manifestation of acute viral hepatitis E. The incidence is reported to be around 5%–6% in the available case series. It has usually been reported in non-fulminant cases of acute viral hepatitis E in the second or third week of illness, with a favourable outcome. Here, we report the case of a young male subject with acute viral hepatitis E presenting as acute pancreatitis at its onset and exhibiting a prolonged recovery phase. To the authors’ knowledge, such a presentation of acute viral hepatitis E as acute pancreatitis at its inception has been only sparsely reported in the available literature.

Prurigo Nodularis Occurring in Conjunction with a Common Blue Nevus / 대한피부과학회지

No abstract available.