1/11. Stress-related primary intracerebral hemorrhage: autopsy clues to underlying mechanism.BACKGROUND: research into the causes of small-vessel stroke has been hindered by technical constraints. Cases of intracerebral hemorrhage occurring in unusual clinical contexts suggest a causal role for sudden increases in blood pressure and/or cerebral blood flow. CASE DESCRIPTION: We describe a fatal primary thalamic/brain stem hemorrhage occurring in the context of sudden emotional upset. At autopsy, the brain harbored several perforating artery fibrinoid lesions adjacent to and remote from the hematoma as well as old lacunar infarcts and healed destructive small-vessel lesions. CONCLUSIONS: We postulate that the emotional upset caused a sudden rise in blood pressure/cerebral blood flow, mediating small-vessel fibrinoid necrosis and rupture. This or a related mechanism may underlie many small-vessel strokes.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/11. Acute eosinophilic myocarditis in a young woman.The first stage of eosinophilic myocarditis is called the necrotizing phase. This stage of eosinophilic myocarditis of unknown cause is often fulminant and rapidly fatal, occurring predominantly in males. Here, we report a case of eosinophilic myocarditis in the acute necrotizing phase occurred without known cause in a 23-year-old Japanese female. Severe diffuse hypokinesis of the left ventricular wall motion (ejection fraction 19.3%), significant concentric edematous thickening of the left ventricular wall (20.1 mm in diastole) and a moderate amount of pericardial effusion (10 mm wide echo free space posteriorly) were revealed by echocardiography. eosinophils were observed and degranulated eosinophilic cationic proteins were stained with antibody against eosinophilic cationic proteins (EG2) in the myocardial specimens obtained by myocardial biopsy. In spite of its severity, the disease resolved promptly with steroid therapy.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
3/11. Reconstructive surgery for a defect in the shaft of the ulna due to osteomyelitis. Long-term result of a case.An eight and a half-year-old boy suffered from chronic osteomyelitis of the left ulna with sinuses, destruction of the middle three-quarters with the presence of necrotic bone and posterolateral dislocation of the radial head. The operative treatment included sequestrectomy and gradual reduction of the radial head after application of an Anderson apparatus. In a second procedure a corticocancellous tibial bone graft was used to bridge the ulnar gap, and later the redislocated radial head was excised. At the latest follow-up, 45 years postoperatively, the limb is fit with normal muscle strength and very satisfactory motion of the elbow and wrist joints, and the patient works as a hard manual laborer.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
4/11. Effect of myocutaneous inflammatory changes caused by intra-arterial chemotherapy on the outcome of patients who undergo limb-saving surgery.BACKGROUND: This study examined the effect of myocutaneous inflammatory changes caused by intra-arterial chemotherapy on the outcome of patients who undergo limb-saving surgery. methods: One hundred seven patients with malignant bone and soft tissue tumors were administered intra-arterial cisplatin and caffeine preoperatively with or without doxorubicin. Nine patients (8.4%) who had had myocutaneous inflammatory reactions were reviewed to determine the effects of this complication on limb-saving surgery. RESULTS: The patients complained of unbearable and continuous pain while undergoing intra-arterial infusion. gait disturbances and muscle weakness were caused by their severe regional pain, resulting in the use of crutches even before surgery. Extended areas of necrotic skin and muscle were resected simultaneously with limb-saving surgery on four patients. Myocutaneous necrosis in one patient, indurations in two patients, and flares in two patients were not treated surgically. Pain relief was provided to eight patients at some point. Four patients with extensive myocutaneous necrosis around the knee joint had restricted range of motion and poor functional results. radionuclide angiography using 99m-technetium-macroaggregated albumins was performed to evaluate the blood flow to the affected muscle and tumor. It showed marked increase of the radioisotope perfusion in the affected muscles but little uptake in the tumor. These results may suggest that the affected muscles diminish the effects of anticancer drugs on the tumors. CONCLUSIONS: Myocutaneous inflammatory reactions should be prevented if possible to obtain good limb function and chemotherapeutic effects in patients who undergo intra-arterial chemotherapy. Resection of necrotic tissue is mandatory to relieve pain.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
5/11. A syndrome of transient left ventricular apical wall motion abnormality in the absence of coronary disease: a perspective from the united states.BACKGROUND: The syndrome of chest pain associated with characteristic anterior electrocardiographic changes, moderate increases in cardiac enzymes, and a reversible apical wall motion abnormality in the absence of coronary artery disease has been documented in japan, but has received relatively little attention in other countries. methods: The clinical and echocardiographic data of 12 patients (11 women, mean age 64 /-14 years) who presented with chest symptoms, electrocardiographic (ECG) changes indicative of an acute anteroapical myocardial infarction, abnormal cardiac enzyme levels and echocardiography showing an apical wall motion abnormality were collected. coronary angiography was performed in 10 patients. A follow-up echocardiogram was obtained within 2 weeks of the initial diagnosis in most cases. RESULTS: An identifiable, precipitating ("trigger") event could be identified in all 12 individuals. Respiratory distress was present in 7, the death of a relative in 3, in 4 a surgical or medical procedure had been performed, and in 1 a panic disorder was diagnosed. The echocardiograms showed a characteristic wall motion pattern of significant apical dysfunction. All of the patients who underwent coronary arteriography had noncritical coronary artery disease. Follow-up echocardiography showed normalization of the LV dysfunction in all instances. CONCLUSION: We identified a syndrome of chest pain, dyspnea, ECG and enzyme changes mimicking acute myocardial infarction, similar to the "Takotsubo" syndrome described in japan. It is likely that the widespread use of echocardiography, coupled with increased recognition of this syndrome, will result in this diagnosis being made more commonly.- - - - - - - - - - ranking = 3.5keywords = motion (Clic here for more details about this article) |
6/11. Granulomatous inflammation and nerve necrosis in a case of apparent idiopathic vocal fold paralysis: report of a case.OBJECTIVES: We will present clinical and pathologic findings of the recurrent laryngeal nerve of a 54-year-old man with apparent idiopathic vocal fold paralysis and discuss clinical and scientific implications of these findings. STUDY DESIGN: Our design is in the format of a case report with emphasis on the clinical, intraoperative, histologic, and neuropathologic findings, followed by a discussion of contemporary theories of idiopathic unilateral vocal fold immobility and the implications of our findings. methods: A 54-year-old man presented with a 2-year history of unilateral vocal fold motion impairment (VFMI) after an upper respiratory infection. Radiographic and laboratory data revealed no organic cause. The patient clinically appeared to have a classical unilateral vocal fold paralysis and had previously undergone collagen injection and medialization thyroplasty, each with only temporary improvement of voice. We performed ansa cervicalis-recurrent laryngeal nerve anastomosis. RESULTS: Intraoperative dissection revealed an indurated and thickened section of nerve approximately 15 mm in length, located at the beginning of the intralaryngeal segment, near the cricothyroid joint. Segments of this nerve were submitted for histologic evaluation, revealing necrosis with granulomatous inflammation. Postoperative electromyography and videostrobolaryngoscopy were consistent with successful reinnervation from the ansa procedure. CONCLUSIONS: The diagnosis of "idiopathic VFMI" likely represents a number of distinct pathologic entities. This case highlights our lack of understanding of idiopathic VFMI and raises many important questions regarding our current theories of this diagnosis. The clinical and pathologic implications are discussed, and continued investigation is recommended.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
7/11. A patient with ankylosing spondylitis who presented with chronic necrotising aspergillosis: report on one case and review of the literature.Upper lobe fibrobullous disease is a well-known finding in advanced stages of ankylosing spondylitis (AS). In this report, we present a 57-year-old male patient who was diagnosed with a right apical cavitary lesion after coming to us with the complaint of haemoptysis. The patient underwent upper lobe segmentectomy and an aspergilloma was detected. Histologic findings were in favour of necrotising aspergillus pneumonia. It was interesting that the patient had not been diagnosed with AS before and presented initially with chronic necrotising aspergillus pneumonia. In the literature, there are recently published series of pulmonary high-resolution computed tomography (HRCT) in AS which claim that parenchymal abnormalities are quite frequent. Although the clinical significance of these abnormalities is not known with certainty, it has been reported that they might be seen even in early-stage patients. It is suggested that the pulmonary involvement in AS might be affected by mechanical factors related to limitation of motion of the thoracic cage and also by parenchymal inflammation. Here, we review the series of pulmonary HRCT in AS patients.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
8/11. Transfer of innervated split latissimus dorsi free musculocutaneous flap for flexion and extension of the fingers.A severe form of Volkmann contracture is associated with loss of flexor and extensor compartment muscles. An 11-year-old boy with Volkmann contracture was admitted to our clinics with flexion contracture of the wrist joint and total loss of flexor and extensor muscle functions. Split latissimus dorsi free flap was used for reconstruction. The muscle was split based on the branching of thoracodorsal nerve and artery within the muscle so that each part of the muscle is nourished and innervated by a branch of thoracodorsal nerve and artery. No complication has occurred, and the patient can now grasp objects, although he cannot achieve full range of motion of the fingers. We performed a single muscle transfer for reconstruction of both the extensor and flexor compartments in severe form of Volkmann contracture and omitted the use of a second muscle transfer, thus greatly decreasing the operative time, cost, and morbidity.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
9/11. Primary articular osteochondroses.Primary articular osteochondroses involve the primary articular and growth cartilage and the subjacent endochondral ossification, with resulting incongruity of the joint surface and potential degenerative osteoarthritis. weight-bearing areas, such as the metatarsal head, are at greater risk than nonweight-bearing parts in the upper extremity, such as the capitellum of the humerus. Treatment has two phases: protected mobilization, followed by graduated functional activity; later, surgery may be required to correct the resultant degenerative osteoarthritis. The accepted period for protected mobilization of the symptomatic patient is two to three years in the upper extremity, but three years or even longer in the weight-bearing lower extremity. The longer the period of painful motion, the longer the period of indicated protected mobilization. The prognosis concerning degenerative osteoarthritis should not be estimated by the extent of acute articular involvement on roentgenograms, but rather by the duration of symptoms.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
10/11. Subacute diencephalic angioencephalopathy--report of an additional case.The following report presents an additional example of subactue diencephalic angioencephalopathy. The patient, a 68-year-old man, unexplicably withdrawn and asocial throughout his life, presented with an altered mental status of relatively recent onset. His illness was marked by progressive dementia and ended in death within 7 weeks. The neuropathologic findings were essentially identical to those described in the previous case in both their histology and topographic localization within the thalamus. The etiology, pathogenesis, and reason for the localization of this entity are unknown. Nevertheless, the lesion underscores the major role of the thalamus in cognitive function, emotional behavior, and awareness.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
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