1/10. Acute disseminated encephalomyelitis in adults: a reappraisal of clinical, CSF, EEG, and MRI findings.OBJECTIVES: To establish an adequate definition of acute disseminated encephalomyelitis (ADEM) in adults, based on our clinical observations of a case-series. methods: Over a period of three years 10 adult patients with a para- or postinfectious disseminated (diffuse or multifocal) syndrome of the CNS fulfilling predefined strict criteria for the diagnosis of ADEM were encountered and systematically followed. RESULTS: The age ranged from 21 to 62 years, two were men. MRI was normal in 5 patients and only mildly abnormal in the remaining patients. CSF was normal in 5 patients and mildly abnormal in the remainder, EEG was abnormal in 7/8 patients. All patients survived and were followed over a period of 30 months (range: 8 to 48 months). Nine patients were left with some residual defects, consisting most often of a mild cognitive impairment. CONCLUSIONS: The EEG as an investigation of brain function can be crucial in establishing the organic nature of disease. MRI is important to exclude other diffuse or multifocal encephalopathies. However, in contrast to previous reports in the literature abnormal MRI should not be considered mandatory in adult ADEM. Difficulties in the diagnosis of ADEM are discussed and the importance of clinical and paraclinical findings for establishing the diagnosis is outlined.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/10. Fatal case of inhalational anthrax mimicking intra-abdominal sepsis.In this report, we discuss the second fatal case of inhalational anthrax related to the use of bacillus anthracis spores as a biological weapon in the united states. This case highlights two of the major characteristics of inhalational anthrax: the fulminating nature of the infection and the difficulty of promptly establishing a diagnosis. In the patient discussed here, gastrointestinal symptoms and findings were so impressive that the patient was thought to have a primary intra-abdominal condition. In the current situation, in which bioterrorism is a real threat, any patient presenting with a flulike or gastrointestinal illness should be queried about their occupation. Anyone with evidence of systemic disease who resides or works in a geographical region where anthrax cases are occurring should be treated until the diagnosis of anthrax is excluded. In the united states, the group that is at high risk for anthrax has shifted from rural farm workers to city dwellers, especially postal workers and public figures.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/10. Bilateral postinfectious optic neuritis and intravenous steroid therapy in children.Six patients presented with acute, simultaneous, bilateral optic neuritis. Five of the six patients admitted to a recent history of a brief upper respiratory or gastrointestinal illness, presumably viral in nature. visual acuity was severely reduced in all patients. Five of the six patients also demonstrated marked neurologic deficits, including seizure activity and cerebellar dysfunction. Three patients demonstrated enhancing intracranial lesions on magnetic resonance imaging (MRI) consistent with demyelinative plaques, whereas lumbar puncture was abnormal in three patients. HLA tissue typing was performed on five of the six patients. All patients were treated with intravenous methylprednisolone, followed by a 2-month tapering course of oral prednisone. Each patient experienced a rapid and nearly complete recovery of vision during treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/10. legionnaires' disease--the Benidorm episode.The clinical pattern of illness in 2 fatal cases of legionnaires' disease is described. Common factors in the 2 patients were residence in a hotel in Benidorm, spain, a severe and progressive pneumonia unaffected by wide-spectrum antibiotics and failure to incriminate an infecting organism. The similarities with the philadelphia outbreak, in which a bacillus known as the Legionnaire agent was isolated, led to a retrospective diagnosis in the Benidorm episode. Subsequent serological surveys indicate that legionnaires' disease is widespread in nature; it is not a new disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/10. The cough and the bedsheet.Of 33 patients with psychogenic cough tic, 31 were successfully treated using an unusual reinforced suggestion technique. The cough usually follows an incidental upper respiratory tract infection and persists as a loud paroxysmal barking or honking sound for weeks to months. Paroxysms occur all day but cease with sleep. The diagnosis is often delayed for weeks to months while the patient is exposed to an increasing intensity of diagnostic procedures and therapy. Thirty percent of some 20 patients previously reported in the literature had been hospitalized. The reinforced suggestion technique depends upon the physician's convincing the patient that the persistent cough has weakened the chest muscles, which are now unable to contain the cough, and that a bedsheet tightly wrapped around the chest will provide the necessary support to stop the cough within 24 to 48 hours. The typical patient can produce the cough on command, has an ambivalent response to the prospect of care, is unconcerned about his symptoms, submits willingly to the examination and procedures, and is kept out of school for the duration of the cough. Findings on physical examination are normal except for abnormal gag and corneal reflexes. The gag reflex was depressed in six and absent in 20 of the 31 patients. The corneal reflex was depressed in 16 and absent in 5 of the 31 patients. These abnormal responses help to corroborate the psychogenic etiology. Early recognition of the nonorganic nature of this syndrome will reduce parental anxiety, loss of school time, risk of iatrogenic complications, and unnecessary medical and hospital expense.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/10. Metastatic anaerobic orbital subperiosteal abscess: value of CT scanning.A case of subperiosteal abscess associated with acute sinusitis is reported. The case is remarkable in that anaerobic organisms played a major role in the pathologic process. In addition, the unusual superolateral position of the abscess in the absence of any defect in the bony sinus walls suggests the hematogenous spread of the sinus infection. The use of Ct scanning proved to be essential in determining the true nature of the orbital pathology.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/10. Epicondylitis after treatment with fluoroquinolone antibiotics.We report two cases of epicondylitis of the elbow occurring after treatment with fluoroquinolone antibiotics. Both patients had intense pain which appeared very shortly after the first dose of the drug and was not relieved by conservative treatment. ultrasonography revealed extensive inflammatory lesions with pseudonecrotic areas. MRI confirmed the lesions and also showed a subclinical abnormality of the adjoining tendons. The persistent nature of the pain was the indication for surgical release of the extensor mechanism. After operation pain disappeared completely and the patients were able to return to their normal activities. Lesions of the tendo Achillis are a well-known side-effect of treatment with fluoroquinolone. Our two cases show that such lesions may occur elsewhere. They also indicate the need for caution when prescribing these antibiotics to patients at risk of tendon lesions, such as top-level sportsmen or patients on dialysis or steroid treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/10. Serial sputum cell counts in the management of chronic airflow limitation.This case study illustrates the usefulness of serial induced sputum cell counts from cytospins to investigate the nature of airway inflammation in a patient presumed to have prednisone-dependent asthma for 30 yrs. She had bronchiectasis and chronic airflow limitation. Exacerbations of breathlessness were associated with an increase in chronic airflow limitation with little or no sputum. Induced sputum showed elevated total cell and neutrophil counts at each exacerbation with no increase in the proportion of eosinophils. Pathogenic bacteria were cultured at each flare-up. The dose of prednisone was reduced progressively and each exacerbation was treated with an appropriate antibiotic without increasing the dose of prednisone, as was the case previously. The infections were associated with bronchiectasis of the right upper lobe which was removed. Examination of the specimen confirmed neutrophilic infiltration and did not show the usual airway structural changes of asthma. These results provide further evidence of the value of sputum cell counts in practice, in this case to prevent overtreatment with prednisone in a patient with recurrent deteriorations in airflow which were due to recurrent infections.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/10. ampicillin-associated colitis.Pseudomembraneous colitis has been increasingly observed after therapy with several antibiotics including ampicillin. This report describes the clinical and pathologic features of a patient who developed pseudomembraneous colitis while receiving ampicillin. The strikingly characteristic nature of these lesions is discussed and early diagnosis in the prevention of a potentially hazardous disorder is emphasized.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/10. Intrathoracic presentation of amebic liver abscess.Amebic infection is endemic in tropical and subtropical countries and still remains a common cause of chronic morbidity in these areas. This is a report of 10 patients with different intrathoracic presentations of amebic liver abscess who were treated surgically after conservative measures had failed. Five of these patients had empyema when first seen, 3 had lung abscess, and 1 had intrathoracic shadow that proved on exploration to be an amebic liver abscess. All of these 9 patients had abscesses on the right side secondary to amebic liver abscess of the right lobe of the liver. The tenth patient had amebic pericarditis secondary to amebic abscess of the left lobe of the liver. Failure of conservative treatment in these patients is attributed to the thick nature of the amebic pus and the severe reaction of the pleura and pericardium to the amebic infection. To avoid the serious complication of pleuropulmonary amebiasis, early operation is advised for large liver abscesses that are unlikely to be controlled by conservative treatment. Transpleural drainage of such abscesses gives direct approach to their sites, which are commonly located in the superior part of the right lobe of the liver. Such drainage has proved to be safe provided that the patient is receiving antiamebic drug treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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