Large-Area SiPM Pixels (LASiPs): A cost-effective solution towards compact large SPECT cameras.

Single Photon Emission Computed Tomography (SPECT) scanners based on photomultiplier tubes (PMTs) are still largely employed in the clinical environment. A standard camera for full-body SPECT employs ~50-100 PMTs of 4-8 cm diameter and is shielded by a thick layer of lead, becoming a heavy and bulky system that can weight a few hundred kilograms. The volume, weight and cost of a camera can be significantly reduced if the PMTs are replaced by silicon photomultipliers (SiPMs). The main obstacle to use SiPMs in full-body SPECT is the limited size of their sensitive area. A few thousand channels would be needed to fill a camera if using the largest commercially-available SiPMs of 6 × 6 mm2. As a solution, we propose to use Large-Area SiPM Pixels (LASiPs), built by summing individual currents of several SiPMs into a single output. We developed a LASiP prototype that has a sensitive area 8 times larger than a 6 × 6 mm2 SiPM. We built a proof-of-concept micro-camera consisting of a 40 × 40 × 8 mm3 NaI(Tl) crystal coupled to 4 LASiPs. We evaluated its performance in a central region of 15×15 mm2, where we were able to reconstruct images of a 99mTc capillary with an intrinsic spatial resolution of ~2 mm and an energy resolution of ~11.6% at 140 keV. We used these measurements to validate Geant4 simulations of the system. This can be extended to simulate a larger camera with more and larger pixels, which could be used to optimize the implementation of LASiPs in large SPECT cameras. We provide some guidelines towards this implementation.

Carcinoma erysipelatoides-cutaneous lymphatic vessel spread of a poorly differentiated naso-pharyngeal carcinoma.

Carcinoma erysipelatoides, which is frequently called inflammatory carcinoma, is an uncommon form of skin metastasis. It originates most commonly from breast carcinoma and less often from endometrial or bronchogenic carcinoma. The naso-pharynx is an unusual source for carcinoma erysipelatoides. We present a case of carcinoma erysipelatoides due to poorly differentiated naso-pharyngeal carcinoma.

Bullous erysipelas: A retrospective study of 26 patients.

BACKGROUND: Erysipelas is a superficial form of cellulitis caused by a variety of microbes, and it responds to antibiotic treatment. During the past few years we treated several patients with a bullous form of erysipelas involving the lower legs. We believe their disease had a more protracted course than patients with nonbullous erysipelas. OBJECTIVE: We studied bullous erysipelas by conducting a retrospective analysis of 26 patients with bullous erysipelas of the legs treated by the authors during a 5-year period. METHODS: We conducted a retrospective review of the records of all patients with a diagnosis of bullous erysipelas who were treated at the Department of Dermatology, Hadassah Medical Center, Jerusalem, between the years 1992 and 1996. Data regarding patients with nonbullous erysipelas were obtained from the medical center's computerized data pool. RESULTS: A total of 26 cases of bullous erysipelas were found, comprising 22 women and 4 men whose ages ranged from 28 to 87 (mean, 58.8) years. The average hospital stay was 20.57 days (range, 12 to 46 days). The average hospital stay for patients with nonbullous erysipelas and cellulitis treated in the same department by the authors during the study period was 10.6 days (range, 2 to 54 days). CONCLUSION: Bulla formation is a complication of erysipelas, seen in our series in 5.2% of the patients (26 of 498 admissions for erysipelas and cellulitis). The course of the disease is protracted, requiring longer medical attention.

Prevalence of spotted fever group rickettsiae in ticks from southern Israel.

The prevalence of spotted fever group rickettsiae was studied in questing ticks collected from southern Israel. Ticks were examined from an agricultural settlement (kibbutz Ze'elim), an endemic site for Mediterranean spotted fever, and from another kibbutz (Re'im) in an adjacent area where the disease has not been reported. Ticks were collected by flagging and CO2 traps from vegetation inside and outside the settlements during 1989/1990 and 1994. In Ze'elim, 98% of the ticks collected were brown dog tick, Rhipicephalus sanguineus (Latreille), whereas in Re'im the predominant species was Rhipicephalus turanicus Pomerantzev (84.6%), with 11.8% of the ticks R. sanguineus and 3.6% Hyalomma excavatum Koch. The presence of rickettsiae in the hemolymph of the ticks was demonstrated by immunofluorescence using polyclonal antibodies made against the human pathogenic Moroccan strain of Rickettsia conorii. Of 549 ticks examined in 1989/1990 from Ze'elim, 7.3% were positive for spotted group rickettsiae, and in Re'im 2.2% of 156 R. turanicus were positive. In 1994, 51 out of 186 (27.4%) ticks in Ze'elim and 3 out of 115 (2.6%) ticks in Re'im were positive. All 20 specimens of H. excavatum were negative for spotted fever group rickettsiae. To our knowledge, this is the 1st report of spotted fever group rickettsiae in R. turanicus from Israel.

Knuckle pads--a forgotten skin condition: report of a case and review of the literature.

A 12-year-old boy presented with knuckle pads, palmar keratoderma, and hand eczema. Since Morginson's description of knuckle pads associated with other dermatoses almost forty years ago, little attention has been given to this disorder. We describe a case and review some of the clinical aspects of this disorder.

Emphysematous gastritis secondary to ingestion of large amounts of Coca Cola.

Acute emphysematous gastritis (AEG) is a life-threatening disease in which gas-forming bacteria invade the gastric wall and cause acute inflammation of it. The clinical presentation of the patient with AEG is stormy: severe sepsis which usually leads to an early death. Presented herein is a case of a 16-yr-old boy with AEG. There were no predisposing factors to the condition in this case. Gas invaded the stomach wall and portal venous system, as well as the duodenal wall, a finding that has not been reported previously. The clinical course was very severe but, in contrast to previously reported cases, recovery was very rapid and left no sequelae.

Co-existence of pheochromocytoma and a recent Epstein Barr virus infection.

A patient with co-existent pheochromocytoma and a recent Epstein Barr virus (EBV) infection is described. He presented with sub-febrile temperature, paroxysmal epigastric burning sensation and an abdominal mass simulating the spleen.

[Anaphylactic reaction to oral penicillin].

Anaphylactic reactions are often caused by parenterally administered penicillin. However, oral penicillin can also produce severe reactions. A 34-year-old man developed anaphylaxis 30 minutes after oral intake of 400,000 units of phenoxymethyl penicillin. He developed hypotension and angioedema which responded well to subcutaneous adrenalin and to intravenous fluids.

[Use of acetaminophen in the community].

Acetaminophen (Acamol) is one of the most widely used medications in children. The recommended dose is 10-15 mg/kg every 4 hours, and up to 5 doses a day. In a prospective study in an outpatient clinic, 101 parents of children 5 years old or younger were asked to describe their use of acetaminophen for their children, including dose, mode administration and maximal frequency of administration for fever. 2/3 used the syrup and 1/3 used suppositories. The average single dose was 13.8 +/- 5.5 mg/kg. Only 61% of the children received reasonable quantities of acetaminophen per dose. While 12% got an overdose of 20 mg/kg or more, 27% got an underdose of less than 10 mg/kg. Treatment was as often as every 2-3 hours in 13% of the children but only once every 8-24 hours in 22%. To overcome inadequate administration of acetaminophen, parents must be properly educated.

[Renewal of oral therapy for diabetes mellitus after secondary failure].

Oral hypoglycemic agents are widely used in the treatment of Type 2 diabetes mellitus. Secondary failure of therapy with these agents is defined as failure after six months of successful treatment. Most cases of secondary failure need insulin permanently. However, a few might again benefit from oral agents after a short period of tight glycemic control, as in the patient presented.