Nodular fasciitis: clinical characteristics and preoperative diagnosis

BACKGROUND AND PURPOSE

Because of its rapid growth, hypercellularity, and brisk mitotic rate, nodular fasciitis (NF) is probably the most common benign mesenchymal tumor that is misdiagnosed as a sarcoma, often leading to unnecessary and overly aggressive therapy.

METHODS

This retrospective study evaluated the characteristics of 92 well-documented cases of NF treated from 1988 to 2001. Gender, age, location, size, and clinical symptoms were analyzed, as was the accuracy of preoperative diagnosis.

RESULTS

Females were predominant (male-to-female ratio, 1:1.71; p = 0.006, binomial distribution). Accurate preoperative diagnosis was made in only 14.1%, but this rate improved in recent years (p = 0.034, chi-squared test for trend). The pathologic subtype of NF did not correlate with the duration of the lesion.

CONCLUSIONS

Clinicians should include NF in the differential diagnosis of rapidly growing subcutaneous tumors and not rush to overly aggressive therapy.

Plateau Behavior in the Chiral Luttinger Liquid Exponent

The current-voltage power law exponent, alpha, for electron tunneling into chiral Luttinger liquids at the fractional quantum Hall edge is found to exhibit a plateaulike structure at alpha close to 3 as the filling factor, nu, is varied. The presence of a plateau near alpha = 3 strongly suggests a fundamental connection between alpha and the structure of the underlying quantum ground states associated with the robust incompressible nu = 1/3 Hall fluid. However, the position in the inverse filling factor where the plateau occurs can vary between samples and appears shifted to values higher than expected from theory.

Recurrent acute encephalopathy due to fatty acid metabolic defect--report of two cases

An increasing number of reports indicate that patients with some inherited metabolic diseases may have symptoms resembling those of Reye's syndrome. We describe 2 patients who developed Reye-like syndrome at the age of 7 months respectively. Conscious disturbance, hepatomegaly, impaired liver function, hyperammonemia, and nonketotic hypoglycemia were noted during acute episode. Blood lactate level was normal in both cases. Liver and muscle biopsy of both patients showed macrovesicular fatty change. Increased density of matrix in hepatocyte mitochondria was noted in patient 1. Stacking of cristae was shown in patient 2. The first patient had another episode of hyperammonemia at 2 years of age. The second patient was admitted three more times due to recurrent vomiting and conscious change at the age of 7 months, 10 months and 13 months respectively. Fatty acid metabolic defect should be considered in children or infants with recurrent Reye-like syndrome.

[Study of rat control by using bait box]

This study examines the feasibility of using bait boxes for permanent rat control in Taiwan. During the test period between October 1988 and March 1989, 37 bait boxes made of PVC pipes were placed at various baiting sites in public markets, near restaurants and food stands in several communities known to be infested by rats. Each of the 37 boxes was baited with non-toxic rice powder to determine how well these boxes were accepted, the time needed for rats to use the boxes and eat the bait, and to do preliminary census on the relative densities of rat populations at these different places. The results showed that 27 of 29 (93.1%) bait boxes that had not been vandalized, disturbed or moved away and could be monitored continuously were used by rats. Of these 27 bait boxes, 13 (48.1%) were used the day after the boxes were set, and 25 (92.6%) were used within a week after the boxes were set. The amount of bait eaten per day for each bait box varied greatly, from less than 5 g to more than 300 g. After the bait in each bait box was taken regularly, half of the bait boxes with good bait acceptance were pulse-baited with 0.005% brodifacoum coated rice powder, and the other half of the bait boxes with good bait acceptance were baited with non toxic rice powder for comparison. The result of treatment indicated that rat control by using bait boxes is effective. However, the cooperation of the local people and the location of bait boxes have a great influence over the success of this control method.

Efficacy of carbamazepine in assaultive patients with frontal lobe dysfunction

1. A double-blind pilot study using a reversal design was conducted to examine the efficacy of carbamazepine in four cases of assaultiveness associated with frontal lobe dysfunction compared to five control cases. 2. Frontal lobe patients who received carbamazepine demonstrated a pattern of improvement on all cognitive, affective, and behavioral measures. This was followed by return to pretreatment level (measures of assaultiveness, depression, and general cerebral efficiency) or sustained improvement (measures of frontal lobe efficiency) when carbamazepine was discontinued. Control subjects showed only minimal differences across testing.

Diphenylhydantoin teratogenicity in man

A case is presented of fetal teratogenic damage from an unusually high maternal dosage of diphenylhydantoin, 600 mg daily, to a 40-kg woman throughout pregnancy. The anomalies included narrowed ends of the fingers and toes; aplasia of the nails on the other fingers and toes; aplasia of the distal phalanges of the fingers and toes; a broad, depressed nasal bridge; anteverted nostrils; prominent upper lip; coarse, profuse scalp hair; pilonidal sinus; and simian crease of the left hand. At the age of 7 months, ossification of the distal phalanges of both middle fingers appeared, the anterior fontanel was small, brain development was retarded, cranial asymmetry was marked, and the fingertips showed a pattern of low arch dermal ridges.

Neuroanatomic projections related to biting attack elicited from ventral midbrain in cats

A single electrode was implanted in each of ten cats at a point in the ventral midbrain from which nonaffective biting attack on a rat could be elicited by electrical stimulation. A lesion was then made which was just large enough to eliminate the elicitation of attack at suprathreshold intensities from that electrode. After post-lesion survival times of 3-14 days the cats were sacrificed, and the degeneration resulting from the lesions was followed with the use of modified Nauta silver stains. Four additional cats were used as anatomic controls. Degenerating fibers were observed to descend bilaterally through the midbrain, pontine, and medullary tegmentum to the vicinity of the principal sensory and motor nuclei of the trigeminal nerve. There was, in addition, evidence of degenerating terminals within the nucleus of the facial nerve and the spinal nucleus of the trigeminal nerve. Of particular note was the observation that the degenerating fibers in the region of the nucleus of the spinal tract of the trigeminal nerve terminated in glomeruli in the rostral portion of the nucleus. Degenerating fibers ascending from the lesion were found to course along the medial forebrain bundle into the hypothalamus and the midline thalamus in a pattern very similar to that previously demonstrated after lesions of biting attack sites in the hypothalamus. The role that the neural pathways associated with ventral midbrain attack sites might play in the mediation of behavior patterns which are elicited during attack stimulation was discussed and it was concluded that the demonstrated neural pathway could provide a cogent explanation for some of the properties of centrally elicited attack behavior.

Biting attack elicited by stimulation of the ventral midbrain tegmentum of cats

An area in the ventral midbrain tegmentum has been discovered in which electrical stimulation elicits biting attack. The midbrain sites from which attack was elicited correspond well with the zone in the midbrain tegmentum where degeneration was previously observed after lesions were made in lateral hypothalamic attack sites.

Neural pathways associated with hypothalamically elicited attach behavior in cats

Small electrolytic lesions were made in cats through electrodes, which, when stimulated, elicited either quiet biting attack or affective paw strike attack upon rats. The Nauta method for impregnating degenerating axoplasm was used to reveal that degeneration resulting from lesions at quiet attack sites followed largely along the course of the medial forebrain bundle, while the degeneration after lesions of affective attack sites was concentrated more heavily in the periventricular system.