Primary duodenal tuberculosis: a case report.

Gastroduodenal tuberculosis (TB) is a rare condition and is often associated with pulmonary TB. We report the case of a primary duodenal TB in an immunocompetent patient without evidence of pulmonary TB. Diagnosis of this disease is difficult and is often confused with chronic peptic ulcer disease. Literature data concerning this challenging diagnosis are analysed.

[Discordance between actual and radiologically estimated size of an incidentaloma. Delay in questions regarding operative decision-making criteria]. / Discordance entre la taille réelle d'un incidentalome surrénalien et son estimation radiologique. Remise en question des critères décisionnels opératoires.

AIM OF THE STUDY: The accurate assessment of tumour size is an important consideration during preoperative evaluation of adrenal tumors, particularly incidentaloma; however the "size criteria" is still a controversial topic in some respects: size is a bad indicator of malignancy, there is still a confusion in the "grey zone" for tumors between 3 and 6 cm, and no universal consensus on the exact cut-off value for resection has been agreed. Nowadays it is clearly accepted that the "size criteria" alone is extremely limited in the assessment of adrenal tumor, moreover some studies suggested the relative inaccuracy of conventional CT in evaluating the size: radiological examination underestimated consistently adrenal tumor size. The aim of this study was to confirm those suggested data. PATIENTS AND METHODS: Our study compared the radiological estimated size and the histological size of 26 incidentaloma operated on with a laparoscopic approach. RESULTS: Our data confirm the inaccuracy of CT and MRI in predicting the size of incidentaloma particularly for tumor measuring less than 3 cm. CT and MRI significantly underestimated size of adrenal tumors, 108% for MRI and 101% for CT-scan. CONCLUSION: The decision to operate, even with the advent and safety of laparoscopic adrenalectomy, cannot only rely on the "size criteria". Radiologists have to perform multiple 1 mm cuts until the very superior and inferior tip of this tumor in order to provide a better estimation of the size.

Iatrogenic thyrotoxicosis. Causal circumstances, pathophysiology and principles of treatment. Review of the literature.

Thyrotoxicosis is the clinical syndrome that results when tissues are exposed to high levels of circulating thyroid hormones. In most instances, thyrotoxicosis is due to hyperthyroidism, a term reserved for disorders characterized by overproduction of thyroid hormones by the thyroid gland. Nevertheless, thyrotoxicosis may also result from a variety of conditions other than thyroid hyperfunction. The present report focuses on the etiologies, pathophysiology and treatment of iatrogenic thyrotoxicosis. Iatrogenic thyrotoxicosis may be caused by 1) subacute thyroiditis (a result of lymphocytic infiltration, cellular injury, trauma or radiation) with release of preformed hormones into circulation, 2) excessive ingestion of thyroid hormones ("thyrotoxicosis factitia"), 3) iodine-induced hyperthyroidism (radiological contrast agents, topical antiseptics or other medications). Among these causes of iatrogenic thyrotoxicosis, that induced by the iodine overload and cytotoxicity associated with amiodarone represents a significant challenge. Successful management of amiodarone-induced thyrotoxicosis requires close cooperation between endocrinologists and endocrine surgeons. Surgical treatment may have a leading yet often underestimated role in view of the potential life-threatening severity of this disease, whereas others kinds of iatrogenic thyrotoxicosis are usually treated conservatively.

Neglect after right insular cortex infarction.

BACKGROUND AND PURPOSE: Case reports have shown an association between right insular damage and neglect. The aim of this study was to examine the incidence of neglect among patient groups with right or left insular infarction. METHODS: We examined neglect in 9 right-handed subjects with insular stroke as evidenced by CT and/or MRI scans (4 with right insular and 5 with left insular cerebrovascular accident) between 4 and 8 weeks after acute stroke with tests of visual, tactile, and auditory perception. RESULTS: Compared with patients with left insular lesions, patients with right insular lesions showed significant neglect in the tactile, auditory, and visual modalities. CONCLUSIONS: The right insular cortex seems to have a role in awareness of external stimuli, and infarction in this area may lead to neglect in multisensory modalities.

Cognitive impairment in the euthymic phase of chronic unipolar depression.

Cognitive functioning in the nonsymptomatic phase and the long-term cognitive outcome of patients with mood disorders are both heuristic and important clinical issues in the study of mood disorders. Literature findings are inconsistent because of design confounds. We tried to address these issues while controlling for several confounds including age, education, gender differences in neurobehavioral functioning, and diagnosis. Nonsymptomatic patients with a history of chronic unipolar depression and bipolar affective disorder and healthy male individuals were administered neuropsychological tests to assess attention, visual-motor tracking, executive abilities, and immediate verbal memory. Subjects had comparable depression scores at the time of testing. Disease duration was 7.5 years (SD 5.1) for unipolar and 11 years (SD 7.3) for bipolar patients. Unipolar patients were more impaired than healthy normal comparison subjects on measures of visual-motor sequencing (Trail Making Test A, p < .05), executive function (Trail Making Test B, Stroop Test Color/Word Trial, p < .05), and immediate memory and attention (CERAD 1st trial, WAIS Digit Symbol subtest, p < .05). Differences between bipolar patients and normal comparison subjects did not reach significance in any of the selected measures. Male patients with a history of chronic unipolar disorder are at risk for cognitive impairment in the nonsymptomatic phase of their disease. Cognitive disturbance is the type seen with prefrontal dysfunction and may be assessed with standard neuropsychological assessments.

An integrative model for the study of developmental competencies in minority children.

In this article a conceptual model for the study of child development in minority populations in the United States is proposed. In support of the proposed model, this article includes (a) a delineation and critical analysis of mainstream theoretical frameworks in relation to their attention and applicability to the understanding of developmental processes in children of color and of issues at the intersection of social class, culture, ethnicity, and race, and (b) a description and evaluation of the conceptual frameworks that have guided the extant literature on minority children and families. Based on the above considerations, an integrative conceptual model of child development is presented, anchored within social stratification theory, emphasizing the importance of racism, prejudice, discrimination, oppression, and segregation on the development of minority children and families.

Clinical utility of the CERAD word list memory test.

The word list memory test from the Consortium to establish a registry for Alzheimer's disease (CERAD) neuropsychological battery (Morris et al. 1989) was administered to 230 psychiatric outpatients. Performance of a selected, age-matched psychiatric group and normal controls was compared using an ANCOVA design with education as a covariate. Results indicated that controls performed better than psychiatric patients on most learning and recall indices. The exception to this was the savings index that has been found to be sensitive to the effects of progressive dementias. The current data are compared and integrated with published CERAD data for Alzheimer's disease patients. The CERAD list memory test is recommended as a brief, efficient, and sensitive memory measure that can be used with a range of difficult patients.

Evidence for a verbal deficit in alexithymia.

This study examined the relationship between alexithymia and specific domains of cognitive function. Fifty-nine neurologically intact combat veterans completed the Toronto Alexithymia Scale (TAS), a number of other symptom measures, and several neuropsychological tests. Modest but consistent correlations were noted between TAS scores and measures of developmental verbal ability. These relationships were not observed between the neuropsychological variables and the other symptom measures. Results suggest that poorly developed verbal ability may relate to the presence of primary alexithymia, irrespective of secondary etiologic factors.

Distinguishing between depression and dementia in the elderly: a review of neuropsychological findings.

Distinguishing between cognitive deficits seen in depression and progressive dementing, diseases is complex and often difficult clinically. We review recent neuropsychological studies comparing normal elderly individuals, depressed patients, and patients with progressive dementias. Findings from these studies suggest that the distinction between depression and dementia is fairly straightforward and facilitated by neuropsychological evaluation. Data from neuroimaging studies of depressed elderly are reviewed and integrated with the neuropsychological findings. A descriptive scheme for categorizing elderly patients is proposed. It is suggested that the label "pseudodementia" be discarded in favor of more thorough description of cognitive deficits associated with various clinical presentations.

Posttrial treatment with ethanol enhances recall of prose narratives.

A small number of studies have examined the effects of postlearning alcohol intoxication on memory for various materials. In contrast to most research examining the effects of alcohol on human memory, these studies demonstrated a facilitation of memory for information learned prior to intoxication. The present study was designed to examine the effects of alcohol on memory for two different kinds of materials. Standard word lists and narrative prose passages were employed to obtain a more detailed picture of the effects of posttrial intoxication with alcohol on memory. Intoxication with alcohol did not affect subject's ability to recall simple word lists. However, recall of prose passages was facilitated to a statistically significant degree. Results are discussed within the context of a current theory of retrograde facilitation of memory via various drugs/substances.

Short-term memory processes following closed head injury.

Survivors of severe closed head injury (CHI) were compared with neurologically normal matched controls on measures of short-term memory processes. The results indicate that patients with CHI took longer to scan their short-term memory than controls, and this increased disproportionately as the memory load increased. The number of errors made in scanning short-term memory increased for patients with CHI, suggesting inefficient as well as slow scanning. These differences were present despite equivalent memory span between groups. The results of this study have implications for day to day memory processes that require manipulation of information in short-term memory.