Invasive oral aspergillosis in a patient with acute myeloid leukaemia

Aspergillosis (a fungal infection by an organism of the Aspergillus species) of the oral cavity is an uncommon condition which most frequently occurs in immunocompromised patients, such as those with haematological malignancies. In such patients, prolonged neutropenia secondary to chemotherapeutic agents enables the spread of invasive aspergillosis, which is unaffected by anatomical barriers. Early detection and treatment of the condition is essential to avoid more serious complications, such as disseminated infection, which results in increased morbidity and mortality. This case report describes a patient with acute myeloid leukaemia who developed localized invasive Aspergillus flavus of the palate. High-dose antifungal therapy was instituted along with surgical removal of the involved tissues. Aspergillosis of the palate was successfully eradicated with no long-term ill effects from the treatment. Management of invasive aspergillosis includes early aggressive antifungal medication combined with surgical removal of the involved tissues.

Efficacy of assessment in fetal behaviour by four dimensional ultrasonography

This study was conducted to examine the behaviour and facial expressions of the fetus after birth by 4-dimensional (4-D) ultrasonography, and the association of the biophysical profile (BPP) with the Doppler scale. A total of 40 singleton pregnancies were included. All 4-D ultrasonographies were performed using the Accuvix XQ (Medison Co. Ltd, Seoul, Republic of Korea). The BPP and Doppler were performed on gravidas using 2-D ultrasonography. We recorded the newborn while awake no later than 48 h after delivery. The most frequent movement in fetuses and newborn was yawning and isolated arm movements, respectively. Sucking, swallowing (r = 0.78) and isolated limb movements (r = 0.72) in fetuses as observed by 4-D ultrasonography had a relationship with isolated limb movements in the newborn. Because of the limitation of ultrasonography, an overall comparison could not be made. There was a high correlation between sucking, swallowing, and isolated limb movements in fetuses and newborn.

An institutional review of paediatric haemangiomas: prevalence, imaging features, and outcomes

OBJECTIVE

To review the demographic data, imaging features, and outcomes of paediatric haemangiomas.

DESIGN

Retrospective study.

SETTING

University teaching hospital, Hong Kong.

PATIENTS

A total of 58 children diagnosed with haemangioma between 1998 and 2007.

MAIN OUTCOME MEASURES

Demographic data, imaging features, type of treatment received, and outcomes.

RESULTS

In all, 19 (33%) of these patients were males and 39 (67%) were females. Most of the lesions (64%) were in the head and neck region. Three (5%) of the patients were complicated by the Kasabach-Merritt syndrome; 21 underwent no imaging, and 37 had ultrasound and/or magnetic resonance imaging. In the majority (85%), ultrasound of the lesions revealed mixed echogenicity and/or phleboliths with variable colour Doppler patterns. On magnetic resonance imaging, most (87%) of the lesions were T1 iso- to hypo-intense and T2 hyperintense with slight heterogeneous signalling and revealed presence of central flow voids (vascular channels) or low-signal areas (fibrous tissue or calcification). In all, 85% appeared homogeneous while 15% showed heterogeneous enhancement. Of 58 patients, 39 (67%) patients received conservative treatment; the lesions resolved spontaneously in 34 (87%) patients, enlarged in 2 (5%), and remained static in 3 (8%). Interventions were directed at the lesions in 19 patients. These entailed surgical excision (n=7), argon laser therapy (n=3), and medical treatment (n=9). Of the latter patients, treatment included: systemic steroids (n=5), interferon (n=1), steroids and interferon (n=1), vincristine (n=1), and sclerotherapy (n=1). Partial or complete resolution of the lesions ensued in 15 (79%) of the patients, while their size remained static in four (21%).

CONCLUSION

Though ultrasound and magnetic resonance imaging features varied, the diagnosis of most haemangiomas could be confidently made by imaging. About 33% of haemangiomas underwent surgical/medical interventions, for which imaging was useful to monitor post-treatment progress.

Pregnenolone sulfate enhances spontaneous glutamate release by inducing presynaptic Ca2+-induced Ca2+ release

Pregnenolone sulfate (PS) acts as an excitatory neuromodulator and has a variety of neuropharmacological actions, such as memory enhancement and convulsant effects. In the present study, we investigated the effect of PS on glutamatergic spontaneous excitatory postsynaptic currents (sEPSCs) in acutely isolated dentate gyrus (DG) hilar neurons by use of a conventional whole-cell patch-clamp technique. PS significantly increased sEPSC frequency in a concentration-dependent manner without affecting the current amplitude, suggesting that PS acts presynaptically to increase the probability of spontaneous glutamate release. However, known molecular targets of PS, such as α7 nicotinic ACh, NMDA, σ1 receptors and voltage-dependent Ca(2+) channels, were not responsible for the PS-induced increase in sEPSC frequency. In contrast, the PS-induced increase in sEPSC frequency was completely occluded in a Ca(2+)-free external solution, and was significantly reduced by either the depletion of presynaptic Ca(2+) stores or the blockade of ryanodine receptors, suggesting that PS elicits Ca(2+)-induced Ca(2+) release (CICR) within glutamatergic nerve terminals. In addition, the PS-induced increase in sEPSC frequency was completely occluded by transient receptor potential (TRP) channel blockers. These data suggest that PS increases spontaneous glutamate release onto acutely isolated hilar neurons via presynaptic CICR, which was triggered by the influx of Ca(2+) through presynaptic TRP channels. The PS-induced modulation of excitatory transmission onto hilar neurons could have a broad impact on the excitability of hilar neurons and affect the pathophysiological functions mediated by the hippocampus.

An unusual case of knee locking

Knee locking is an incapacitating condition that requires urgent orthopaedic intervention. The most common cause is meniscal injury, followed by torn anterior cruciate ligament, osteochondral loose bodies and foreign bodies in the joint space. This report describes a patient who had an unusual case of left knee locking. After clinical examination and radiological investigations, the provisional diagnosis was a lateral meniscal tear, which was not visible on magnetic resonance imaging. Diagnostic arthroscopy of the left knee revealed a 1-cm yellowish lump on the medial meniscus, and the histology revealed pigmented villonodular synovitis. The menisci and cruciate ligaments were intact.

In-situ monitoring of the thermal desorption of alkanethiols with surface plasmon resonance spectroscopy (SPRS)

Thermal desorption investigations on self-assembled monolayers (SAMs) had previously been carried out using techniques such as thermal desorption spectroscopy (TDS), scanning tunneling microscopy (STM) and X-ray photo-electron spectroscopy (XPS). In this paper, the thermal dissociation of alkanethiols (CnH(2n + 1)SH) at various chain lengths (n= 6, 12, 18) on sputtered gold layers was monitored in-situ using the Kretschmann surface plasmon resonance configuration on a spectroscopic ellipsometer. We found that the longest alkanethiol (C18) exhibits the greatest thermal stability, manifested by the least amount of angular shift, during heating, in the resonant spectral features. Predictions of desorption temperatures from SPRS for the longer chain thiols are in good agreement with XPS measurements.

Hydrogenotrophic denitrification in a packed bed reactor: effects of hydrogen-to-water flow rate ratio

Hydrogen dissolution and hydrogenotrophic denitrification performance were investigated in a lab-scale packed bed reactor (PBR) by varying the hydrogen flow rate and hydraulic retention time (HRT). The denitrification performance was enhanced by increasing the hydrogen flow rate and HRT as a result of high dissolved hydrogen concentration (0.39mg/L) and utilization efficiencies (79%). In this study, the hydrogen-to-water flow rate ratio (Q(g)/Q(w)) was found to be a new operating factor representing the two parameters of hydrogen flow rate and HRT. Hydrogen dissolution and denitrification efficiency were nonlinearly and linearly correlated with the Q(g)/Q(w), respectively. Based on its excellent linear correlation with denitrification efficiency, Q(g)/Q(w) should be greater than 2.3 to meet the WHO's guideline of nitrate nitrogen for drinking water. This study demonstrates that Q(g)/Q(w) is a simple and robust factor to optimize hydrogen-sparged bioreactors for hydrogenotrophic denitrification.

Tendon transfer or tendon graft for ruptured finger extensor tendons in rheumatoid hands

We evaluated the clinical outcome of tendon reconstruction using tendon graft or tendon transfer and the parameters related to clinical outcome in 51 wrists of 46 patients with rheumatoid arthritis with finger extensor tendon ruptures. At a mean follow-up of 5.6 years, the mean metacarpophalangeal (MP) joint extension lag was 8 degrees (range, 0-45) and the mean visual analogue satisfaction scale was 74 (range, 10-100). Clinical outcome did not differ significantly between tendon grafting and tendon transfer. The MP joint extension lag correlated with the patient's satisfaction score, but the pulp-to-palm distance did not correlate with patient satisfaction. We conclude that both tendon grafting and tendon transfer are reliable reconstruction methods for ruptured finger extensor tendons in rheumatoid hands.

Orientational relationships and atomic arrangements of GaN nanorods grown on Al2O3 (0001) substrates by using hydride vapor phase epitaxy

Scanning electron microscopy (SEM) images and transmission electron microscopy (TEM) images showed that the one-dimensional GaN nanorods were formed on Al2O3 (0001) substrates by using hydride vapor phase epitaxy without a catalyst. Selected area electron diffraction (SAED) pattern and high-resolution TEM (HRTEM) results showed that GaN nanorods grown on Al2O3 (0001) substrates had crystalline wurzite structures and (0001) preferential orientation. The morphologies of GaN nanorods were affected by the flow rates of the source materials. The orientational relationships between the GaN nanorods and the Al2O3 substrates were (0001)GaN perpendicular (0001) Al2O3 and [0110]GaN perpendicular [1120] Al2O3. Cross-sectional and plan-view atomic arrangements of the fully relaxed interfacial region are described on the basis of the TEM, the SAED pattern, and the HRTEM results.

Novel anti-prostate cancer curcumin analogues that enhance androgen receptor degradation activity

The androgen receptor (AR) plays a crucial role in the physiological and pathological functions of androgen. As a transcription factor, the AR modulates androgen activity by regulating the transcription of target genes that are involved in numerous physiological functions and pathological disorders, such as acne vulgaris, androgenetic alopecia, benign prostate hyperplasia (BPH), and prostate cancers. Although many natural and synthetic curcumin analogues have been reported to possess anticancer activity through a common cytotoxic property against proliferating tumor cells, none has been reported to inhibit cancer cell growth through a more specific mechanism or target in the cancer cells. Recently, new curcumin analogues were studied extensively regarding their synthesis, structure-activity (i.e., anticancer activity) relationships, and mechanism of action. These compounds, such as ASC-J9 and its analogues (3 and 4), have now been shown to inhibit prostate cancer proliferation through a novel mechanism of enhancing AR degradation.

"Can laparoscopy really complete full surgical staging?" A case of early recurrence and malignant transformation of borderline ovarian tumor

Ovarian borderline tumor (BOT) with noninvasive implants traditionally is considered to be non-aggressive. Recurrences are delayed and transformations to high-grade carcinoma are rarely documented. We report on a patient with BOT with early recurrence and high-grade carcinoma transformation in a short interval after complete laparoscopic staging. A 27-year-old unmarried woman presented with a 26 cm in size ruptured left ovarian mass. Laparoscopic left salpingo-oophorectomy with right ovarian biopsies, multiple peritoneal biopsies, omental biopsy and washing cytology were performed. FIGO Stage I ovarian serous borderline tumor with microinvasion was confirmed. About ten months later, a 15 cm in size left BOT recurred and was resected by laparoscopic cystectomy including staging surgery. Seven months after the second surgery, we found a pelvic mass by sonogram and elevated CA125. A third diagnostic laparoscopy revealed invasive serous carcinoma with multiple peritoneal implants. In spite of radical surgery and adjuvant chemotherapy, the patient died of a progressive metastatic liver tumor. A case of early recurrence with malignant transformation of BOT is presented together with a brief review.

Malignant mixed mullerian tumor of the cervix including components of a rhabdomyosarcoma: case report and literature review

Malignant mixed mesodermal tumors (MMMTs) are composed of carcinomatous and sarcomatous components and have an aggressive metastatic potential, resulting in a poor prognosis. MMMTs of gynecologic origin typically arise from either the ovary or the uterus, and MMMTs of the cervix are extremely rare. Due to the rarity of MMMTs arising from the cervix, there is no consensus regarding treatment, prognosis, and outcome; however, aggressive surgical cytoreduction, combined with adjuvant platinum-based chemotherapy and/or radiotherapy, is recommended as the treatment of choice for MMMTs of the cervix. Cervical MMMTs are more often confined to the uterus at the time of diagnosis and frequently have non-glandular epithelial components. For these reasons, MMMTs of the cervix may have a better prognosis compared to the uterine counterparts. A case of an immunohistochemically confirmed primary MMMT of the cervix, including components of a rhabdomyosarcoma, is reported.

An interesting case of recurrent temporomandibular joint dislocation

Acute temporomandibular joint dislocation is an infrequent presentation to the emergency department or to dental practitioners. It may be a rare complication of dental treatment. Recurrent temporomandibular joint dislocation occurs in individuals with certain anatomical abnormalities or systemic conditions. This paper reports an unusual presentation of recurrent temporomandibular joint dislocation and outlines some of the surgical techniques used in managing this condition.

Imperforate hymen: cause of lower abdominal pain in teenage girls

Imperforate hymen is a relatively rare congenital anomaly. However, it is not an uncommon cause of lower abdominal pain presenting in teenage girls. Without careful history taking and thorough examination, the condition can be missed easily. We report an imperforate hymen presenting as abdominal pain in three teenage girls aged 12, 12 and 13 years, respectively, within a six-month period. The presentation was reviewed and the various types of hymenotomy were discussed.

Germ cell degeneration in high-temperature treated pufferfish, Takifugu rubripes

Exogenous factors such as temperature, social behavior, and salinity play a crucial role during the critical sensitive period of sex differentiation in many vertebrates. In fishes, amphibians, and reptiles temperature treatment is known to induce all-male (or female) individuals, and genes related to sex differentiation have been studied. The Japanese pufferfish, Takifugu rubripes, possesses the most compact genome among vertebrates and has immense potential for studies focusing on comparative genome analysis. In this study, we describe gonadal morphology and vasa (germ cell marker) and dmrt1 (Sertoli cell marker) expression on a molecular level in relation to the development of temperature-treated pufferfish. To investigate the relationship between temperature and gonadal development, pufferfish were exposed to high-temperature conditions (32 degrees C) during early gonadal development. Morphological observations showed that this high-temperature treatment did not influence sexual differentiation as determined by ovarian cavity characteristics; however, high-temperature treatment induces gonadal degeneration that is devoid of germ cells. RT-PCR results revealed no vasa expression within germ cell-degenerated gonads. In situ hybridization results showed that dmrt1 was expressed in somatic cells of germ cell-degenerated ovaries. These results suggest that high-temperature treatment during early gonadal development induces germ cell degeneration and masculinization of ovarian somatic cells in pufferfish.

Nonlinear saturation of cyclotron maser instability associated with energetic ring-beam electrons

We study the cyclotron maser instability (CMI) driven by an energetic ring-beam distribution by a particle simulation to explain possible generation mechanisms of intense radiation phenomena observed in space. The main objective is to understand the nonlinear processes that control saturation of the emission process. Our study reveals new issues that have been overlooked in past literature. It is found that electrostatic wave modes excited by the electron beam instability compete with the electromagnetic waves excited by the CMI. Nonlinear effects of these electrostatic modes tend to redistribute the energy of the energetic electrons and make the physics more complicated. The CMI can be much less effective in a realistic case than it is anticipated theoretically.

Brain abnormalities in Sjogren syndrome with recurrent CNS manifestations: association with neuromyelitis optica

Background and objectives

Optic neuritis or longitudinally extensive myelitis in Sjogren syndrome (SS) suggests a neuromyelitis optica spectrum disorder (NMOSD). However, brain abnormalities of SS remain to be elucidated for the association with neuromyelitis optica (NMO).

Methods

Twelve primary SS patients (all women, 42 ± 13.2 years) who had recurrent central nervous system (CNS) manifestations with brain involvement were retrospectively identified. Brain MRI, and neurologic and serologic findings were analyzed with the measurement of anti-aquaporin-4 antibody (AQP4-Ab).

Results

All patients showed brain lesions characteristic of NMO as follows: 1) the involved sites adjacent to the third and fourth ventricles and in the posterior limb of the internal capsule, 2) unique configurations, such as the longitudinal course from the internal capsule to the midbrain, large cerebral or cerebellar lesions over 3 cm, and cavity-like formations. AQP4-Ab was positive in six of eight patients tested, and all the seropositive patients showed lesions with increased diffusion, suggestive of vasogenic edema. Four patients met the revised criteria of NMO, and nine had features of NMOSDs. Of the remaining three patients showing only brain involvement, one had AQP4-Ab.

Conclusions

This study demonstrates that SS patients with recurrent CNS involvement have brain abnormalities characteristic of NMO and AQP4-Ab in Korea. The presence of AQP4-Ab in one SS patient with only brain involvement may suggest that the coexistence of NMO should be explored in SS patients with recurrent CNS manifestations, even without optic neuritis or myelitis.

A multicenter trial of the efficacy and safety of 0.03% tacrolimus ointment for atopic dermatitis in Korea

BACKGROUND

Atopic dermatitis is a chronically relapsing, common inflammatory skin disease, which significantly affects quality of life negatively in many respects. Topical steroids are the mainstay of atopic dermatitis treatment but they carry the risk of local side effects. A topical formulation of tacrolimus, a macrolide calcineurin inhibitor, has recently been developed.

OBJECTIVE

To evaluate the efficacy and safety of 0.03% tacrolimus ointment for the treatment of moderate to severe atopic dermatitis in Korea.

METHODS

An open, non-comparative, multi-center study with 4 weeks' follow-up was performed. A total of 180 patients (aged 2-57 years old) were enrolled. Tacrolimus ointment (0.03%) was applied to all involved areas twice daily. Efficacy was evaluated by an investigator's global assessment, the eczema area and severity index score, and by the patient's assessment of pruritus and clinical response at baseline, and after weeks 1, 2 and 4. Dermatology life quality index (DLQI), children's DLQI (CDLQI) and toddler's DLQI were assessed at baseline and at week 4. The safety assessment included monitoring all adverse events and clinical laboratory values.

RESULTS

All efficacy parameters were improved. The mean EASI (eczema area and severity index) score was 19.7 at baseline and reduced to 8.0 at the end of the study. Moderate improvement was observed by the investigator's global assessment after 4 weeks' treatment. A marked decrease of pruritus was observed, and mild or moderate improvement was observed by patients' global assessments after the treatment period. Significant benefits in terms of quality of life in adults and children with atopic dermatitis were obtained. The most common adverse events associated with tacrolimus treatment were transient skin burning sensation (45.3%) and pruritus (41.6%) at the site of application.

CONCLUSION

0.03% tacrolimus ointment should be considered effective and safe in both Korean children and adults with moderate to severe atopic dermatitis.

Sensitivity enhancement in grating coupled surface plasmon resonance by azimuthal control

We present a method for improving the sensing capability of grating coupled surface plasmon resonance (GCSPR) sensors. The grating is rotated azimuthally (phi) until the excitation of double surface plasmon polaritions (SPPs) by a single wavelength is possible. Close to this condition, further tuning of the incident wavelength will merge the double SPPs into a multi-SPP resonance which is angularly broad but spectrally sharp. This is the condition where the momentum vector of the propagating SPP is perpendicular to the incident light momentum. We demonstrate this sensitivity enhancement on a Au grating surface using a dodecanethiol (C12) self-assembled monolayer (SAM). Using this method, a shift in resonance angle as large as 3 degrees can be observed. The simulated sensitivity of this method shows that a sensitivity up to 800 degrees /RIU is achievable, which is one order of magnitude greater than that in a conventional fixed grating (phi = 0 degrees ) as well as the prism-coupled Kretschmann configuration.

Characterization of congenital vascular malformation in the extremities using whole body blood pool scintigraphy and lymphscintigraphy

The purpose of this study was to investigate the clinical usefulness of combined whole body blood pool scintigraphy (WBBPS) and lymphscintigraphy (LS) in the characterization of patients with congenital vascular malformations (CVMs) of the extremities. Subjects included 134 patients who underwent Tc-99m RBC WBBPS and Tc-99m filtered tin colloid (or antimony sulfur colloid) LS on initial diagnosis. Scintigraphic results were interpreted as arteriovenous malformations (AVMs), venolymphatic malformations (VLMs), lymphatic malformations (LMs), and venous malformations (VMs). Final diagnosis of the type of vascular malformation was determined by physical examination, magnetic resonance imaging (MRI), angiography, duplex ultrasonography, and/or biopsy results. The final diagnosis demonstrated that 14 of the study subjects had an AVM, 29 had a HLM, 20 had a LM, and 71 had a VM. The sensitivity of WBBPS and LS in the characterization of CVM was 85.7% (12/14) for AVMs, 96.6% (28/29) for VLMs, 95.0% (19/20) for LMs, and 88.7% (63/71) for VMs. The specificity was 100% for AVMs (120/120), 91.4% for VLMs (96/105), 99.1% for LMs (113/114), and 98.4% for VMs (62/63). The overall accuracy of WBBPS and LS was 91.0% (122/134). Our results show that combination of WBBPS with LS can characterize extremity CVMs in patients with high diagnostic accuracy, and may thus be useful for making optimal treatment decisions.

Recurrent pancreatitis secondary to pancreatic ascariasis

Ascaris lumbricoides infestations are endemic in tropical countries. Ascaris lumbricoides can occasionally cause biliary obstruction and result in obstructive jaundice or pancreatitis. We present a 34-year-old Bangladeshi woman with biliary ascariasis, resulting in recurrent pancreatitis. Her diagnosis was made with endoscopic retrograde cholangiopancreatography performed during an acute attack of pain.

Patency of splenic vessels after laparoscopic spleen and splenic vessel-preserving distal pancreatectomy

Background

This study evaluated the short- and long-term patency of preserved splenic vessels after laparoscopic spleen-preserving distal pancreatectomy (SPDP) with preservation of the splenic vessels.

Methods

This single-centre retrospective study included all patients who had undergone splenic vessel-preserving laparoscopic SPDP between 2004 and 2007. The patency of the splenic vessels was assessed by abdominal computed tomography and classified into three grades according to the degree of stenosis.

Results

Twenty-two patients were included. The preoperative patency of the splenic artery and vein was normal in 20 and 19 patients respectively. Normal patency of the splenic artery and vein was observed in 16 and five patients respectively within 1 month of surgery, and in 19 and nine patients 6 months or more after operation. Nine of ten patients with complete splenic vein occlusion developed a collateral circulation in the late postoperative phase. Splenic perfusion was well preserved in all patients.

Conclusion

Splenic vessel-preserving laparoscopic SPDP has the short-term benefit of good perfusion to the spleen. In the long term, there is a risk of left-sided portal hypertension if the splenic vein becomes occluded after surgery.

Human anti-alpha-enolase antibody in sera from patients with Behçet's disease and rheumatologic disorders

OBJECTIVE

alpha-Enolase is a target antigen of IgM-type anti-endothelial cell antibody in patients with Behçet's disease (BD). The objective of this study was to assess the reactivity of serum anti-alpha-enolase antibodies in BD and in other rheumatologic diseases, and to evaluate the clinical significance of serum anti-alpha-enolase antibodies in BD.

METHODS

Enzyme-linked immunosorbent assay (ELISA) and immunoblotting were used to examine serum samples from patients with BD (n=100), systemic lupus erythematosus (SLE) (n=50), systemic sclerosis (n=21), rheumatoid arthritis (RA) (n=20), Takayasu's arteritis (n=20), dermatomyositis (n=17), mixed connective tissue disease (MCTD) (n=11), and samples from healthy volunteer donors (n=23). The medical records of patients with BD were reviewed to investigate their clinical characteristics.

RESULTS

Specific positive signals against recombinant human alpha-enolase were detected by IgM ELISA of serum samples from 56 of the 100 BD patients (56.0%), 24 of the 50 SLE patients (48.0%), 15 of the 21 systemic sclerosis patients (71.4%), 13 of the 20 RA patients (65.0%), 10 of the 20 Takayasu's arteritis patients (50.0%), 9 of the 17 dermatomyositis patients (52.9%), and 5 of the 11 MCTD patients (45.5%). The number of BD patients with vascular lesions was significantly higher in the anti-alpha-enolase antibody positive group than in the negative group (p=0.027).

CONCLUSION

We demonstrated the reactivities of serum anti-alpha-enolase antibodies in BD and other rheumatologic diseases with moderate specificity and also found that serum anti-alpha-enolase antibodies in BD can be associated with vascular system involvement.