1/7. Exceptionally long absence status: multifactorial etiology, drug interactions and complications.To our knowledge, petit mal status lasting longer than 2-3 days has been documented only once [1]. We report a 66 year-old man with well-documented, idiopathic generalized epilepsy who developed petit mal status lasting 6 weeks. Valproate levels remained low because of interactions with phenytoin. When phenytoin was discontinued, valproate levels increased, and he progressively improved. Chronic ischemic changes in the white matter may have been an additional factor in the causation and, most likely, in the duration of his status. Exceptionally long status and stupor increase the risk of medical complications. Valproate remains the medication of choice for the treatment of petit mal status. Despite the extraordinary course in this patient, complete recovery took place, confirming the benign nature of even such a prolonged episode.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/7. Mucoepidermal carcinoma of the lung detected by positron emission tomography in a 5-year-old girl.The authors describe a rare case of mucoepidermal carcinoma of the lung incidentally identified in preoperative assessments for inguinal hernia repair in a 5-year-old girl. This patient was referred for right external inguinal hernia, and a 3.0-cm round-shaped lesion was found in the right lower lung field of a chest x-ray film. She had no respiratory tract complaints, but her serum carcinoembryonic antigen concentration was markedly elevated (21.2 ng/mL). Chest and abdominal computed tomography/magnetic resonance images could not determine the nature of the lesion, but 2-[18 F]fluoro-2-deoxy- d -glucose positron emission tomography (FDG-PET) indicated a malignant tumor pattern. The patient underwent a computed tomography-guided needle biopsy of the lesion (S8), which was soon followed by a right lower pulmonary lobectomy. Histopathology of the resected specimen showed mucoepidermal carcinoma with no regional lymph node metastasis. In childhood asymptomatic pulmonary lesions, it is often difficult to rule out the possibility of malignancy. In the present case, FDG-PET scanning appropriately indicated the therapeutic priority of pediatric thoracic surgery.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/7. Postoperative abdominal wall hematomas have a distinctive appearance on ultrasonography.In six patients a large abdominal wall hematoma developed 1 1/2 to 6 months after operation. In each case differentiation of incisional hernia from hematoma was difficult, but the distinctive appearance on ultrasonography of an ovoid mass with thick straight internal septae, characteristic of hematoma, was noted in all. ultrasonography also showed the multilocular nature of the lesion which made percutaneous aspiration difficult.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/7. Scintigraphic detection of abdominal wall and diaphragmatic peritoneal leaks in patients on continuous ambulatory peritoneal dialysis.Continuous ambulatory peritoneal dialysis (CAPD) is utilized with increasing frequency for patients with end stage renal disease (ESRD). Several complications have been observed including catheter malfunction due to pericatheter leaks, abdominal wall and inguinal hernias and diaphragmatic leaks. Occasionally special diagnostic procedures are necessary to determine the nature of the abnormality and guide the surgical approach to correction. The four cases herein illustrate the usefulness of radionuclide imaging in diagnosing leakage of dialysate fluid in patients on CAPD.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/7. Inguinal ovaries in children demonstrated by high resolution real-time ultrasound.High resolution real-time ultrasound of two female infants showed normal ovaries located in the inguinal canal and demonstrated cysts within the solid ovarian tissue. As this appearance is quite distinct from that of the solid homogeneous testis, ultrasound can determine the nature of the gonad present.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/7. Hyperexplexia: an inherited disorder of the startle response.A family is presented with hyperexplexia, a rare autosomal dominant neurological disorder. Affected individuals manifest flexor hypertonia and hypokinesia during infancy. Later and throughout life, the condition is characterized by exaggerated involuntary myoclonic startle reactions, which on occasion result in falling. There are also marked nocturnal myoclonic jerks. Many family members have had congenital hip dislocations and inguinal hernias. Pre- and postnatal hypertonia is proposed as the cause for these problems. The nature and location of central nervous system dysfunction in hyperexplexia was investigated using electroencephalographic and brainstem-evoked response techniques. A dysfunction of cortical inhibition of the brainstem-mediated startle response is discussed as a possible pathogenic mechanism. Accurate diagnosis of this disorder is important in order to provide appropriate counseling and to initiate effective treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/7. Mucin deposits within inguinal hernia sacs: a presenting finding of low-grade mucinous cystic tumors of the appendix. A report of two cases and a review of the literature.Two male patients, both 41 years of age, presented clinically with a typical inguinal hernia. The herniorrhaphy specimens were found on routine pathologic examination to contain abundant mucin that was focally organizing and was devoid of associated epithelial cells. Both cases were seen in consultation because of uncertainty as to the nature of the process. The possibility that the mucin might represent spread from an appendiceal mucinous cystic tumor led to the investigation of the appendix and in both cases such a tumor was discovered. The widespread involvement of the peritoneum that is characteristic of pseudomyxoma peritonei was absent in each case. These cases represent one of the many "surprise" findings that may be encountered in hernia sac specimens and one of the many problematic pathologic manifestations that may be associated with low-grade mucinous neoplasms of the appendix. Although this phenomenon is described in the literature, experience with our two cases indicates that it may still pose a significant diagnostic challenge.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |