Nodal cryptococcal immune reconstitution inflammatory syndrome masquerading as tuberculosis in an HIV-infected patient.

An African HIV-infected patient presented with widespread necrotic lymphadenopathy five months after starting combination antiretroviral therapy (cART) and was thought to have disseminated tuberculosis in the context of an immune reconstitution inflammatory syndrome (IRIS) on the basis of typical imaging appearances and suggestive appearances from a fine needle aspirate of a nodal mass. The patient deteriorated despite empirical antituberculosis therapy and the correct diagnosis of nodal cryptococcal infection was subsequently established by histological examination of a core biopsy from a lymph node. IRIS should be borne in mind when considering the differential diagnosis in a patient who has recently started cART.

Thorax and pelvis kinematics change during sustained cycling.

The aim of this study was to evaluate time dependent changes in 3 dimensional (3D) thorax and pelvis kinematics during an intense 60 min bike ride. 10 experienced male road cyclists pedalled for 60 min at workloads based on previous onset of blood lactate accumulation (OBLA) testing. The 60 min cycle was divided into six 10 min periods consisting of 8 min of steady state cycling (88% of OBLA) followed by 90 s at 140% of OBLA and a 30 s recovery phase (60% of OBLA). Thorax and pelvis kinematic data were recorded from 20 consecutive pedal revolutions using a 3D motion capture system (200 Hz) during each steady state phase. Repeated measures ANOVA with Bonferroni corrections were used to test for effects of test duration on segmental kinematics. Results indicated an effect for test duration on the mean thorax (p<0.001) and pelvic tilt (p=0.042), pelvic lateral tilt velocity (p=0.006) and the ROM in thoracic lateral tilt (p<0.001). These changes all occurred between the 4th and 5th work periods. Findings indicated that during the latter stages of a high intensity ride cyclists changed the sagittal plane thorax and pelvis orientation, increased lateral thoracic movements and pelvic lateral tilt velocities.

A 7-year-old boy with midline cerebellar mass.

January 2005. A boy aged 7 years was found to have a tumor arising from the roof of the fourth ventricle. Histopathologically, part of the tumor appeared as a PNET, while neuroglial tissue, striated and smooth muscle, cartilage and small glandular structures were present in other regions. Tumor cells in both primitive and mature elements showed a loss of chromosome 17p accompanied by a gain of 17q, a pattern consistent with the presence of an isochromosome 17q. This abnormality is not characteristic of intracranial germ cell tumors, but is present in over 30% of medulloblastomas. On the basis of the histologic and genetic abnormalities, we propose a diagnosis of PNET with multilineal differentiation.

The renal handling of insulin and thyroid hormones in normal man.

1. The renal extraction of insulin and thyroid hormones T3 and T4 was studied in man by right renal vein catheterization. 2. The mean renal extraction of insulin was 0-46, suggesting that the right renal vein should be utilized in comparable studies. 3. No renal extraction of thyroid hormones was detected.