Giant cell tumor of the talus: A case report.

Giant cell tumor is a benign primary bone neoplasm which most often occurs in a periarticular location. Involvement of the bones of the foot and ankle is rare, and there have been a limited number of previous case reports involving the talus. Here we report a case of giant cell tumor of the talus, which was initially radiographically occult in a 43-year-old female, with emphasis on MRI imaging characteristics. The patient underwent surgical excision and curettage. Histological examination revealed the presence of spindle cells admixed with giant cells, confirming GCT. We further provide an overview of the radiological findings of GCT. Giant cell tumor is a benign bone neoplasm of mesenchymal origin, identified by multinucleated giant cells [1]. GCT is locally aggressive and can destroy adjacent bone and articulations. The most commonly affected bones are the distal femur, proximal tibia, and distal radius, with an epiphyseal predominance in 90% of cases [2]. Presentations are mostly mono-ostotic, however multicentricity may occur in younger patients [3]. Very few cases have been reported in the bones of the feet, an incidence of 1%-2% have been previously reported [4]. GCT is seen between ages 20 and 40 years, with a 56% predominance in females [3]. Although benign, 1%-9% cases may "metastasize" to the lungs. The initial treatment is surgical removal, either en bloc, or more commonly intralesional curettage and the use of adjuvants. Even after resection, GCT has a high recurrence rate [2]. The trigger for GCT is currently unknown. However, a majority of cases have cytogenetic abnormalities of telomeric associations (tas). Involvement of the RANK pathway is also believed to contribute to the pathogenesis of GCT [2].

When is neuropsychological testing medically necessary for children on medicaid in New Mexico?

Healthcare for poor children, also known as Medicaid, is disproportionately relied upon by citizens of poor states such as New Mexico, where (a) there are more unintended pregnancies, (b) domestic violence during and after pregnancies occurs with regularity, (c) youth substance use is much more common, (d) crime rates are some of the worst in the country, (e) many never graduate from high school, and (f) incarceration is often inevitable. Yet, there is a dearth of research into the neuropsychological health of these children. Meanwhile, nonneuropsychologists working for managed care organizations routinely deny authorization for neuropsychological testing based on a lack of medical necessity. The present article addresses the question of neuropsychological medical necessity using community-based neuropsychological data from New Mexico collected on Medicaid and non-Medicaid youth via retroactive chart review. Downstream fiscal implications that are related to the eventual cost of mental illness and crime among those with poor neuropsychological health are discussed.

The Benefit of Mirtazapine in the Treatment of Progressive Multifocal Leukoencephalopathy in a Young HIV-positive Patient: A Case Report.

Highly active antiretroviral therapy is well-established in the treatment of human immunodeficiency virus (HIV)-positive patients. Nonadherence with therapy regimens often leads to the occurrence of opportunistic infections that further complicate treatment and challenge the treating physician. We report a young HIV-positive patient who suffered from progressive multifocal leukoencephalopathy caused by the human John Cunningham virus and showed objective clinical improvement after adding mirtazapine to the treatment regimen, an observation that is supported by the emerging literature.

Double right coronary artery and its clinical significance: Review of the literature.

Double right coronary artery is a very rare anomaly that is usually discovered incidentally during conventional coronary angiography. Double right coronary artery may have clinical implications in symptomatic patients requiring percutaneous coronary intervention and may be associated with other congenital abnormalities, myocardial ischemia and ventricular fibrillation in the absence of atherosclerosis. Here the reported cases in the literature are reviewed and a case of double right coronary artery with ischemia in inferior left ventricular wall is presented.

Neurocysticercosis of the fourth ventricle associated with hydrocephalus.

Neurocysticercosis is a parasitic infection of the central nervous system with the cysts of Taenia solium, the pig tapeworm. Infection presents with a pleomorphic picture depending on the stage and location of the infection and the immune response of the infected host. Historically confined to the developing world, neurocysticercosis is no longer limited to endemic regions, as globalization, travel, and immigration permit the spread of the infection. We report a young Hispanic patient who was diagnosed with neurocysticercosis of the fourth ventricle and subsequent hydrocephalus.

Sinonasal Fungal Infections and Complications: A Pictorial Review.

Fungal infections of the nose and paranasal sinuses can be categorized into invasive and non-invasive forms. The clinical presentation and course of the disease is primarily determined by the immune status of the host and can range from harmless or subtle presentations to life threatening complications. Invasive fungal infections are categorized into acute, chronic or chronic granulomatous entities. Immunocompromised patients with poorly controlled diabetes mellitus, HIV and patients receiving chemotherapy or chronic oral corticosteroids are mostly affected. Mycetoma and Allergic Fungal Rhinosinusitis are considered non-invasive forms. Computer tomography is the gold-standard in sinonasal imaging and is complimented by Magnetic resonance imaging (MRI) as it is superior in the evaluation of intraorbital and intracranial extensions. The knowledge and identification of the characteristic imaging patterns in invasive - and non- invasive fungal rhinosinusitis is crucial and the radiologist plays an important role in refining the diagnosis to prevent a possible fatal outcome.

Fungal Infections of the Central Nervous System: A Pictorial Review.

Fungal infections of the central nervous system (CNS) pose a threat to especially immunocompromised patients and their development is primarily determined by the immune status of the host. With an increasing number of organ transplants, chemotherapy, and human immunodeficiency virus infections, the number of immunocompromised patients as susceptible hosts is growing and fungal infections of the CNS are more frequently encountered. They may result in meningitis, cerebritis, abscess formation, cryptococcoma, and meningeal vasculitis with rapid disease progression and often overlapping symptoms. Although radiological characteristics are often nonspecific, unique imaging patterns can be identified through computer tomography as a first imaging modality and further refined by magnetic resonance imaging. A rapid diagnosis and the institution of the appropriate therapy are crucial in helping prevent an often fatal outcome.

Magnetic Resonance Imaging of Non-ischemic Cardiomyopathies: A Pictorial Essay.

Non-ischemic cardiomyopathies are defined as either primary or secondary diseases of the myocardium resulting in cardiac dysfunction. While primary cardiomyopathies are confined to the heart and can be genetic or acquired, secondary cardiomyopathies show involvement of the heart as a manifestation of an underlying systemic disease including metabolic, inflammatory, granulomatous, infectious, or autoimmune entities. Non-ischemic cardiomyopathies are currently classified as hypertrophic, dilated, restrictive, or unclassifiable, including left ventricular non-compaction. Cardiovascular Magnetic Resonance Imaging (CMRI) not only has the capability to assess cardiac morphology and function, but also the ability to detect edema, hemorrhage, fibrosis, and intramyocardial deposits, providing a valuable imaging tool in the characterization of non-ischemic cardiomyopathies. This pictorial essay shows some of the most important non-ischemic cardiomyopathies with an emphasis on magnetic resonance imaging features.

Assessment of Ischemic Cardiomyopathy Using Cardiovascular Magnetic Resonance Imaging: A Pictorial Review.

Ischemic heart disease is the leading cause of death worldwide. In the last two decades, cardiovascular magnetic resonance imaging (CMRI) has emerged as the primary imaging tool in the detection and prognostic assessment of ischemic heart disease. In a single study, CMRI allows evaluation of not only myocardial wall perfusion, but also the presence, acuity, and extent of myocardial ischemia and infarction complications. Also, rest and stress perfusion imaging can accurately depict inducible ischemia secondary to significant coronary artery stenosis. We present a pictorial review of the assessment of ischemic cardiomyopathy with an emphasis on CMRI features.