Melanocitoma meníngeo del ángulo pontocerebeloso: claves imagenológicas para su abordaje / Cerebellopontine meningeal melanocytoma: keys for imaging diagnostic approach

Resumen: Las lesiones del ángulo pontocerebeloso (APC) representan el 6 al 10% de las neoplasias intracraneales, siendo los schwannomas vestibulares y meningiomas los más comunes. Sin embargo, hasta el 15% pueden ser otras lesiones, entre ellas las derivadas a partir de restos de células melanocíticas presentes en las leptomeninges. El diagnóstico diferencial de las patologías tumorales del APC es extenso, siempre teniendo en cuenta las lesiones más comunes. Sin embargo, cuando las características radiológicas no son las esperadas, el enfoque debe orientarse hacia las lesiones inusuales, poniendo en contexto las diferentes estirpes celulares que pueden dar origen a las neoplasias en esta localización, como las neoplasias melanocíticas. Se presenta el caso de un masculino de 74 años con síndrome cerebeloso de tórpida evolución, al cual se le realiza RM de cerebro contrastada, identificando una lesión de base dural en el APC izquierdo, con hiperintensidad de señal en T1 e hipointensidad en T2, atípico para las lesiones más comunes en esta región, que sugiere su contenido melanocítico.

Abstract: Cerebellopontine angle tumors (CPA) represent approximately 6 to 10% of intracranial tumors. Vestibular Schwannomas and meningiomas are the most common, however up to 15% can be of other origin, including from melanocytes derived from the neural crest. The differential diagnosis of CPA pathologies is extensive, always taking into account the most common ones. However, if the radiological characteristics are not the expected, the approach should be directed towards unusual lesions, putting into context the different cell lines that can give rise to the neoplasm at this location, such as melanotic neoplasms. We present a case of a 74-year-old male, who presented with a cerebellar syndrome. Due to an atypical clinical evolution, a contrast enhanced head MRI was performed, revealing a dural based tumor on the left CPA, which was hyperintense on T1 and hypointense on T2 weighted sequences, which is not expected from the common lesions at this region and suggested it's melanotic content.

Antimicrobial efficacy of photodynamic therapy, diode laser, and sodium hypochlorite and their combinations on endodontic pathogens.

BACKGROUND: Sterilization of the root canal system is of prime importance for a successful root canal therapy. Lasers and photodynamic therapy (PDT) have become the latest choice to eradicate microorganisms in the root canal. OBJECTIVE(S): To evaluate and compare the antimicrobial activity of diode laser, photodynamic therapy, and sodium hypochlorite along with their combinations on endodontic pathogens: Enterococcus faecalis and Streptococcus mutans. METHODS: A total of 120 uniradicular teeth were stored in 5.2% NaOCl solution to remove organic residues and the crowns were sectioned at the cemento-enamel junction (CEJ) to obtain root canal length of 15 mm. Canals were shaped using step-back technique up to #40 K-file and were autoclaved. The selected teeth (specimen) were randomly divided into two equal groups with sixty teeth being inoculated with E. faecalis (Group E) and remaining sixty teeth with S. mutans (Group S). Further, the groups were subdivided according to the disinfection technique used. Ten teeth from each subgroup were disinfected with a diode laser, photo activated disinfection (PAD), sodium hypochlorite, a combination of sodium hypochlorite and diode laser, a combination of sodium hypochlorite and photo activated disinfection respectively. Ten teeth in each group served as control without any disinfection. The treated specimens were transferred to test tubes containing 5 ml sterile Luria Bertani broth, incubated and the bacterial count, optical density in each root specimen was calculated and compared. The pairwise comparison of colonies across the subgroups was done by the Kruskal-Wallis test and within the subgroups was carried out using the Mann-Whitney U test. The statistical implication was tested at 5% and the study was performed using SPSS 18.0 ver. (SPSS Inc.). RESULTS: A significant reduction (98%) in the E. faecalis count was observed when the NaOCl was used in combination with the diode laser or PAD. PAD along with 3% NaOCl presents the advantage of utilizing a lower wavelength laser beam. Hence, PAD in combination with NaOCl can be an alternative and better option for root canal disinfection for both the endodontic pathogens, E. faecalis and S. mutans.

Morphological and morphometric features of scaphoid bone in north eastern population, India.

A study was performed to analyse the morphometry and morphological variants of adult scaphoid bone in Sikkimese population of North Eastern India. The study included 100 dry human scaphoid bones. The bones which had previous signs of fracture were excluded. The morphometric parameters were measured with vernier caliper of 0.02 mm accuracy; the circumferences were measured by placing a thread around them and measuring its length. A magnifying lens was used to observe the number of foramina. From our observations, 22 (44%) of the left scaphoid were having conical shape and 28 (56%) were pyramidal in shape. On the right side, 36 (72%) had conical shape and 14 (28%) were pyramidal. All the bones had waist, except one right sided scaphoid (2%) in which the waist was absent. The scaphoid had main dorsal sulcus in 63% of cases, 29% had two dorsal sulci and 6% had Y shaped sulci. The dorsal sulcus was absent in 3 cases (1 on left side and 2 on the right side). All the scaphoids had a minimum of one foramen in the main dorsal sulcus and 92% had more than one foramen. The present study has provided the additional information on morphology and morphometry of adult human scaphoid bones in north eastern population, India. We believe that the data obtained from the present study are important for the hand surgeons and radiologists. The details obtained will also be helpful for the morphologists and clinical anatomists.

A preliminary survey of the median artery in human cadavers of South Indian origin.

BACKGROUND: The median artery is a transitory vessel that represents the arterial axis of the forearm during early embryonic life. It normally regresses in the second embryonic month. Its persistence in the human adult has been recorded in 2 different patterns: as a large, long vessel (palmar type) which reaches the hand; or as a small and short vessel (antebrachial type) which ends before reaching the wrist joint. The palmar type is of major clinical significance. OBJECTIVE: This study was undertaken to investigate the incidence and course of the palmar type of the median artery in South Indian cadavers. MATERIAL AND METHODS: 25 upper limbs of South Indian cadavers were taken to study the median artery. RESULTS: The occurrence of median artery was 8%; of which 4% was on the right side and the other 4% was on the left side. On both sides, the artery originated from the ulnar artery. On the right side, the artery was involved in the formation of superficial palmar arch, whereas the artery on the left side did not join the arch; it terminated as 1st and 2nd common palmar digital arteries. CONCLUSION: Persistent median artery is closely related to the anterior interosseous nerve, it is possible that the artery may compress the anterior interosseous nerve and cause the anterior interosseous nerve syndrome (Fig. 2, Ref. 17).

Bone marrow culture vs. blood culture in FUO.

INTRODUCTION: Bone marrow culture is considered superior to blood culture in evaluation of FUO. The aim of this study was to compare the usefulness of these two cultures. METHODS: A one year prospective cross sectional study was conducted to find out the usefulness of bone marrow culture and blood culture in the diagnosis of FUO. Marrow aspirates in each case were sent for bacterial, myocbacterial and fungal culture. Simultaneously venous blood was sent for bacterial culture. The results of BMCs and BCs were compared. RESULTS: Total 57 cases of FUO were included in the study. Male female ratio was 1.22:1. Age range was five to 83 years (median 30). Duration of fever was 21 to 365 days. Bacterial growth was seen in nine cases (15.78%) of BMCs and in three cases (5.26%) of corresponding BCs. Fungal or myocbacterial growth was not seen. Salmonella typhi was the commonest organism isolated in BMCs (three cases) followed by Staphylococcus aureus (two cases), Escherichia coli, Non fermenting Gram negative bacilli, Enterococcus species and Salmonella paratyphi-A (one case each). Two cases of Salmonella typhi and one case of Salmonella paratyphi-A were isolated in BCs. CONCLUSION: BMCs are more useful than BCs in evaluation of patients with FUO, especially in cases of salmonella infection and are particularly important when the patient has already taken antibiotics. In immuno-competent patients presenting with FUO, BMCs for mycobacteria or fungi is unlikely to yield any growth.

Pulmonary parenchymal splenosis.

We describe the cytologic findings of a case of pulmonary parenchymal splenosis, a rare condition that follows lacerating trauma to the spleen, and may masquerade as a metastatic neoplasm. Approximately 24 cases of thoracic splenosis have so far been reported, the vast majority presenting as pleural-based nodules, and the cytological features of only two cases, both belonging to the latter group, have been described. We believe our case report to be the first to describe the cytological features of an intrapulmonary splenosis, and its features differ from the prior cases by having a mixed inflammatory cell infiltrate, with a predominance of lymphocytes, plus pulmonary macrophages and occasional endothelial cells. This condition has variable cytological features, but the correct diagnosis can be made in the presence of appropriate history and radiographic findings. Confirmation may require biopsy or radionucleide imaging.

[Control of the obese population. Educational intervention program]. / Control de la población obesa. Programa de intervención educativa.

The purpose of this article is to discover the age, sex and risk factor differences among a group of obese people who participate on a pedagogical program designed for weight loss and one which is not designed for weight loss and to establish the effectiveness of the aforementioned pedagogical program on those obese people who participate in that same program. To these ends, a non-controlled, prospective study was carried out in "L'Eixample" Primary Health Clinic in Lérida. From a group of 192 obese patients at a General Medicine clinic, 93 followed an individualized educational intervention program by means of scheduled nurse visits over a one year time period. This individualized educational program was based on: health information and records, nutritional education, physical exercise, motivation and help during follow-up sessions; all carried out under a scheduled nurse's control program. He overall effectiveness of this program has been 51.6%, or 48 patients; this program should be directed to the under 65 obese age group which do not have any risk factors.

Müllerian-type epithelial tumor arising within a torsed appendix testis.

Because it is a remnant of the müllerian duct system, the appendix testis contains müllerian epithelium that theoretically may produce epithelial tumors similar to those that occur in the female genital tract. Few reports of tumors of müllerian origin arising in the testis exist, and rarely are neoplasms arising from the appendix testis identified. We present a case of a serous cystic neoplasm of low malignant potential derived from müllerian-type epithelium that was located in the torsed appendix testis of a young, otherwise healthy, boy.

[The predictive signs of multivessel coronary disease in echocardiography with dobutamine]. / Signos predictores de enfermedad coronaria multivaso en la ecocardiografía con dobutamina.

AIMS: To assess the ability of dobutamine echocardiography to detect multivessel coronary artery disease and to determine predictive factors for multivessel disease with or without beta-blockers. PATIENTS AND METHODS: A total of 101 patients underwent dobutamine stress echocardiography and coronary angiography (evaluation of chest pain 76, extent of coronary disease after myocardial infarction 19, other indications 6). RESULTS: Ten patients in whom the test was prematurely terminated were excluded. Out of 91 patients who underwent dobutamine echocardiography, 54 patients had multivessel disease (sensitivity of dobutamine test 93%, specificity 46%). Heart rate at the maximum dose of dobutamine or atropine was 88 +/- 21 beats/min for multivessel diseases and 104 +/- 21 beats/min without multivessel disease (p < 0.001). A cut-off value < 94 beats/min discriminated patients at risk for multivessel disease. After adjusting for treatment with beta-blockers, heart rate < 94 beats/min, ECG signs of ischemia, and abnormalities on baseline echocardiogram with remote asynergies during dobutamine testing were independent predictors of multivessel disease in the multivariate analysis (probability > 90% when at least two factors were present). CONCLUSION: A heart rate < 94 beats/min at peak dose of dobutamine or after atropine, ECG signs of ischemia, and the presence of abnormalities on echocardiogram at rest with remote asynergies during dobutamine stress testing were independent predictive factors of multivessel coronary artery disease.

Application of the AgNOR method to distinguish pseudoepitheliomatous hyperplasia from squamous cell carcinoma.

The AgNOR stain was performed on seventeen cases of pseudoepitheliomatous hyperplasia of the oral cavity and genital tract, seventeen cases of squamous cell carcinomas of the same regions, and nineteen cases of squamous cell carcinoma of the cervix, to determine whether the stain could help to distinguish pseudoepitheliomatous hyperplasia from squamous cell carcinoma. No constant relationship of the AgNOR score to the grade of the lesion could be determined. Follow up of some of the cases was possible. Here, too, it was seen that the AgNOR score could not reliably predict which cases of pseudoepitheliomatous hyperplasia would progress to squamous cell carcinoma, and which cases of squamous cell carcinoma would suffer a relapse.

HIV and AIDS in Asia and the Pacific: an epidemiological overview.

PIP: The authors define for the purpose of this overview Asia and the Pacific to be the 46 countries and other administrative areas belonging to the Southeast Asia and Western Pacific regions of the World Health Organization. Defined as such, 55% of the world's population lives in the Asia-Pacific region. China, India, and Indonesia, three of the four most populous countries in the world, are part of the region. The region is highly diverse with highly diverse systems in place to monitor the course of the HIV epidemic. This diversity makes it difficult to develop an accurate picture of the epidemiology of HIV and AIDS in Asia and the Pacific. Despite underreporting and data of varying quality, one may reasonably conclude on the basis of available evidence that countries overall in Asia and the Pacific are in a relatively early stage of the HIV/AIDS epidemic. Reported modes of transmission vary widely and include heterosexual sexual contact, homosexual sexual contact, IV drug use, the receipt of blood products, and mother-to-child transmission. A cumulative total of 851,628 AIDS cases had been reported to the World Health Organization (WHO) by December 31, 1993. Reports from the Asia-Pacific region represent 1% of that total. The WHO estimates that there have been more than 3 million AIDS cases and 14 million infections in adults worldwide since the beginning of the epidemic, while other estimates are substantially higher. The Asia-Pacific region accounts for 3% of the estimated AIDS cases, but 15% of the total estimated HIV infections, indicating the relatively recent arrival of the epidemic to that part of the world. The authors discuss HIV case reporting, surveys of HIV prevalence, risk factors for HIV infection, geographic patterns of HIV transmission, molecular and clinical epidemiology, and the future of the HIV epidemic in Asia and the Pacific.^ieng

Haematuria and proteinuria in urinary schistosomiasis: response to therapy with praziquantel in Tanzanian children.

In order to assess the efficacy of praziquantel against Schistosoma haematobium and its effect on the morbidity indices, haematuria and proteinuria, a study was carried out using school receiving praziquantel at 40 mg/kg body weight. Twenty-four weeks after treatment, the percentage of cure was high and reached 100% among the 'light' and 'moderate' infection groups. In the 'heavy' infection group, a cure rate of 50% and a 69.3% egg reduction was observed. An overall cure rate of 94% was achieved at 24 weeks. Microhaematuria and proteinuria were reduced by 96.6% and 92.5%, respectively.