ABSTRACT
Autoimmune encephalitis is a rare disease, which should be differentiated from aseptic encephalitis. Possessing anti-N-methyl-D-aspartate (NMDA) receptor autoantibody is the leading cause of autoimmune encephalitis. However, it may pose a diagnostic challenge to clinicians, especially to nonpsychiatric or non-neurologic specialist, resulting in a delayed initiation of treatment. Hence, we share the case of a patient with anti-NMDA receptor encephalitis who was hospitalized in the infectious diseases ward, presenting with acute febrile illness that preceded characteristic neuropsychiatric symptoms.
Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , Hashimoto Disease , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/drug therapy , Autoantibodies , Encephalitis , Fever/etiology , Humans , Receptors, N-Methyl-D-AspartateABSTRACT
Facile syntheses of enantiopure trans- and cis-3-hydroxypiperidine derivatives and 3-hydroxypipecolic acids are reported, featuring Rh-catalyzed cyclohydrocarbonylation through common intermediates. A diaxial conformation in a 2,3-disubstituted N-Boc-piperidinyl structure is revealed by an X-ray crystallographic analysis.
Subject(s)
Picolinic Acids/chemical synthesis , Piperidines/chemical synthesis , Catalysis , Crystallography, X-Ray , Models, Molecular , Molecular Conformation , Molecular Structure , Picolinic Acids/chemistry , Piperidines/chemistry , StereoisomerismABSTRACT
OBJECTIVES: The goal of this article is to investigate the factors leading to protracted nasal discharge after pediatric endoscopic sinus surgery. METHODS: A retrospective chart review of all pediatric patients who had received endoscopic sinus surgery for chronic rhinosinusitis between January 2002 and September 2006 was conducted. The patients were assigned to the "protracted" group if they demonstrated persistent mucopurulent nasal discharge for more than 3 months after endoscopic sinus surgery, and otherwise to the "resolved" group. RESULTS: There were 21 "protracted" patients (39.6%) and 32 "resolved" patients (60.4%). Among these patients, age at diagnosis or operation, time from initial diagnosis to operation, and blood eosinophil count did not differed significantly between the "protracted" and the "resolved" groups. On the other hand, sinonasal polyposis (80.9% vs. 53.1%, P=0.039), history of allergic rhinitis (52.4% vs. 12.5%, P=0.002) and gender (male vs. female=80.9% vs. 43.7%, P=0.007) were more frequently observed in the "protracted" group than in the "resolved" group. These associations remained significant in a multivariate logistic regression (odds ratio=9.36, 10.69 and 14.84, respectively). CONCLUSION: Sinonasal polyposis, history of allergic rhinitis and gender were significant and independent risk factors for protracted nasal discharge after pediatric endoscopic sinus surgery. These risk factors should be taken into consideration during preoperative counseling.
Subject(s)
Endoscopy , Postoperative Complications/etiology , Sinusitis/etiology , Sinusitis/surgery , Adolescent , Child , Chronic Disease , Cross-Sectional Studies , Female , Humans , Male , Multivariate Analysis , Nasal Polyps/epidemiology , Nasal Polyps/surgery , Odds Ratio , Postoperative Complications/epidemiology , Radioallergosorbent Test , Retrospective Studies , Rhinitis, Allergic, Perennial/complications , Rhinitis, Allergic, Perennial/epidemiology , Risk Factors , Sex Factors , Sinusitis/epidemiologyABSTRACT
Trigeminal neuropathy is characterized by sensory disturbance of the division of trigeminal nerve, and sometimes is associated with pain. Trigeminal neuropathy secondary to perineural invasion of sinonasal lymphoma is extremely rare. Likewise, sinonasal lymphoma is infrequently demonstrated initially with cranial neuropathy. The present case served to broaden the differential diagnosis of secondary trigeminal neuropathy and to alert clinicians to cautiously assess perineural spread of occult neoplasm in sinonasal tract and larynx or pharynx for cases with evolving trigeminal neuropathy or even other cranial nerve neuropathy in which no definite cause is identified.
Subject(s)
Lymphoma/complications , Paranasal Sinus Neoplasms/complications , Trigeminal Nerve Diseases/etiology , Aged, 80 and over , Humans , Lymphoma/diagnosis , Lymphoma/pathology , Magnetic Resonance Imaging , Male , Paranasal Sinus Neoplasms/diagnosis , Peripheral Nerves/pathology , Trigeminal Nerve Diseases/diagnosisABSTRACT
Burkitt's lymphoma is a common comorbidity of infection with the human immunodeficiency virus, but rarely the initial clinical manifestation of undiagnosed AIDS, especially for the otolaryngologist. We report the case of a patient with recalcitrant rhinosinusitis subsequently diagnosed with sinonasal Burkitt's lymphoma and HIV.
