Idiopathic acute transverse myelitis in a middle-aged woman with progression to nadir in less than one hour.

We report a case of a middle-aged woman, normally fit and well, presenting with acute onset neurological deficit with progression to nadir in <1 hour. Initial MRI spine showed no significant abnormality, although second MRI spine showed abnormal signal in three to four segments with no compressive lesion. CT aortic angiography excluded vascular or ischaemic abnormality. We made a diagnosis of idiopathic acute transverse myelitis (ATM). She was treated with steroids and made significant progress improving from T11 ASIA A paraplegia to T11 ASIA C paraplegia by the time of discharge. Awareness of idiopathic ATM presenting hyperacutely with initial MRI spine being normal is important for prompt diagnosis and management.

Squamous Cell Carcinoma of Thymus Presenting as Constrictive Pericarditis Diagnosed With 18F-FDG PET/CT.

Constrictive pericarditis refers to focal or global thickening of pericardium causing impedance to diastolic filling and increased systemic venous pressure. We discuss a case of thymic carcinoma presenting as constrictive pericarditis. A 70-year-old man experiencing shortness of breath underwent Doppler echocardiography for further evaluation. Echocardiography was suggestive of thickened nodular pericardium with minimal pericardial effusion, and Doppler features were suggestive of constrictive pericarditis. F-FDG PET/CT done to exclude malignancy reveals locally advanced thymic carcinoma spreading along the pericardial sheath with metabolically active rib metastases.

Oxytocic activity of thrombin: modulation of thrombin-induced gravid rat myometrial contractions by 5-hydroxytryptamine receptor antagonists.

BACKGROUND: Thrombin possesses potent oxytocic activity in vitro and in vivo. This activity has been proposed to play a role in post-parturitional uterine contractions and possibly, preterm birth related to intrauterine hemorrhage. Previous workers have demonstrated that cyclo-oxygenase pathway may not play a significant role in oxytocic activity of thrombin. However, the role of 5-hydroxytryptamine (a mediator of some of the biological activities of thrombin) in the oxytocic activity of thrombin is unknown. The present study therefore aimed to examine the possible involvement of 5-hydroxytryptamine in thrombin-induced myometrial contractions. METHODS: Effect of 5-hydroxytryptamine receptor antagonists on thrombin-induced contractions of isolated gravid rat myometrium was studied using isolated tissue bath system. RESULTS: Thrombin-induced myometrial contractions were significantly and concentration-dependently inhibited by ketanserin and methysergide. Furthermore, 12 +/- 2% increase in the force of contractions of gravid rat myometrium pre-contracted with 5-hydroxytryptamine (1 microM) was provoked by 1 U/ml of thrombin. Thrombin-induced augmentation of the uterine stimulating effect of 5-hydroxytryptamine was characterized by pronounced increase in the contractile tone. CONCLUSIONS: 5-hydroxytryptamine may possibly play a role in oxytocic activity of thrombin. Uterine hyperactivity associated with intrauterine hemorrhage could hence involve thrombin-induced 5-hydroxytryptamine production in the uterus.

Acute confusion and blindness from quinine toxicity.

Quinine is widely used for nocturnal leg cramps, despite limited evidence of its clinical efficacy in this condition. Accidental overdose is associated with serious ocular complications and can potentially be fatal. We report the case of a 57-year-old man who presented with acute confusion and bilateral blindness after consuming approximately 7.2 g quinine sulphate along with an unknown quantity of alcohol. He was treated with general supportive measures and nitrates, with an apparent initial recovery, but visual field defects persisted. This case highlights the potential toxic effects of quinine, the dangers of its bulk prescription, and the lack of strict guidelines with regard to its prescription. We suggest that restricted prescribing for leg cramps, better patient education about the toxic nature of the drug, and clear labelling of this hazard on the dispensing bottles might lead to a reduction in the cases of quinine poisoning.