Massive scrotal haematoma: a complication of percutaneous transluminal angioplasty

Scrotal haematoma is an unusual complication following percutaneous transluminal angioplasty. It carries significant morbidity and causes extreme discomfort to the patient. We describe the case of a 75-year-old diabetic man who developed this complication. Recommendations are made for investigation and management of this problem, which is so infrequently encountered in clinical practice.

MR imaging in intramedullary cysticercosis

Although intramedullary spinal cord cysticercosis (IMC) is uncommon, its presence is being increasingly recognised by magnetic resonance imaging. We studied six patients from an endemic region and present the MRI features and clinical correlation of IMC. Six patients who presented with para- or quadriplegia were studied by contrast enhanced spinal MRI. Prompted by the spinal lesions, all patients underwent brain MRI. Clinical data and laboratory studies were reviewed in all patients. Definite diagnosis was established in the form of response to drug therapy (n = 4) and histopathology (n = 2). Follow-up MRI studies of spine and brain were obtained in four patients 2 months after they started medical treatment, regardless of surgery. Five patients showed fusiform and focal enlargement of the spinal cord (cervical 2, thoracic 3). Well-defined cysts with a slightly hyperintense mural nodule were identified in five patients in Ti-weighted images (T1WI). All cysts were hyperintense on T2WI and merged with the surrounding oedema. Oedema extended one to three vertebral levels above or below the cyst. Post-contrast T1WI showed well-defined, ring enhancing lesions with smooth walls in all patients. Symptoms in all patients correlated with the level of the lesions. Brain studies demonstrated lesions in just two patients. Histopathological confirmation was obtained in two patients. Follow-up spinal MRI was normal in two patients, following 2 months of treatment while residual and smaller lesions were seen in two patients. Two patients were asymptomatic and denied follow-up MRI. MRI of spinal cysticercosis were typical of and similar to those seen in cerebral lesions in our patients and corresponded to the level of symptoms. All cysts were surrounded by oedema. Two of four patients showed residual lesions after 2 months of therapy and 33 % of patients showed concomitant intracranial lesions.

Peripheral WBC count and serum prolactin level in various seizure types and nonepileptic events

PURPOSE

To analyze effects of different types of seizures and nonepileptic events as well as effects of seizure duration and lapse between the time of seizure and blood collection on serum prolactin level and peripheral white blood cell (WBC) count.

METHODS

We prospectively collected blood samples from all patients admitted to our Epilepsy Monitoring Unit at baseline and after an event. Blood samples were analyzed, and serum prolactin level and WBC count were determined. Statistical analyses were performed to evaluate the relation of each type of seizure, its duration, and time lapse between a seizure and collection of blood sample to the serum prolactin level and peripheral WBC count.

RESULTS

Serum prolactin level increases above twice the level at baseline after a complex partial seizure or a generalized seizure. Peripheral WBC count is elevated above the upper limit of normal in about one third of cases after a generalized seizure. In generalized seizures, the length of a seizure is positively associated, whereas the lapse time between the seizure onset and blood draw is negatively correlated with the increase in WBC count. Thus the longer the seizure and quicker the blood draw, the higher the WBC count.

CONCLUSIONS

We conclude that complex partial or generalized seizures are associated with an increase in serum prolactin level. Peripheral WBC count increases significantly after a generalized seizure and is probably transient in nature.

Isolated symmetrical mediastinal lipomatosis

Symmetrical mediatinal lipomatosis is a rare benign condition characterized by deposition of a large amount of mature adipose tissue within the mediastinum. Usually secondary to exogenous obesity, administration of steroids and Cushing's disease, it is more common in middle-aged males and is associated with alcohol abuse. Various other associations have been reported. CT and MRI can decisively diagnose this benign condition, which also helps in deciding treatment options. We present a case of a young female with a bizarre appearance on chest radiographs. Isolated, bilaterally symmetrical mediastinal lipomatosis was diagnosed on CT and MRI. The patient was thin and did not consume alcohol or steroids. Cushing's disease and other known associations were excluded.

Spectral karyotyping analysis of head and neck squamous cell carcinoma

OBJECTIVES/HYPOTHESIS

The genetic content of head and neck squamous cell carcinomas is ill defined. Spectral karyotyping (SKY) is a new technique that allows the simultaneous detection of all chromosomal translocations by labeling each individual chromosome with different fluorescent agents. In the current study we used SKY to analyze cell lines and a primary tumor derived from head and neck squamous cell carcinomas (HNSCC) to delineate recurrent translocations and breakpoints.

STUDY DESIGN

Spectral karyotyping analysis of head and neck cancer.

METHODS

Two cell lines (MDA886 and MSK922) and one primary tumor in short-term culture were subjected to metaphase growth arrest with colcemide in their exponential growth phase and fixed onto glass slides. Painting probes for each of the autosomes and the sex chromosomes were generated from flow-sorted human chromosomes using sequence-independent DNA amplification. The probes were labeled using a polymerase chain reaction-based reaction and hybridized to metaphase preparations for 2 days at 37 degrees C. Biotinylated probes were detected using avidin Cy5 and digoxigenin-labeled probes with an anti-mouse digoxigenin antibody followed by goat anti-mouse antibody conjugated to Cy5.5. Chromosomes were counterstained with 4,6-diamino-2-phenyliodole (DAPI), and a minimum of five metaphases were captured and analyzed for each case. Breakpoints on the SKY-painted chromosomes were determined by comparison of corresponding DAPI banding.

RESULTS

Spectral karyotyping analysis revealed a complex pattern of chromosomal abnormalities. A total of 66 translocations were identified in the three cases, with one new recurrent translocation at (der(4)t(4;20)(q35;?)). Nine complex translocations, involving three or more chromosomes, were identified in these cases. Overall, 96 breakpoints were assigned to metaphase chromosomes and another 74 breakpoints could not be assigned. Breakpoints most commonly involved chromosomes in genetic rearrangements were 1, 3, 5, 8, 13, 16, and 17.

CONCLUSIONS

Spectral karyotyping analysis reveals the true complexity of chromosomal aberrations in cell lines derived from head and neck squamous cell carcinomas. The use of SKY, in combination with other techniques, may allow for a more complete assessment of the genetic abnormalities of head and neck cancers and serve as a starting point for gene identification.

A fatty acid desaturase modulates the activation of defense signaling pathways in plants

Salicylic acid (SA) plays an important role in activating various plant defense responses, including expression of the pathogenesis-related (PR) genes and systemic acquired resistance. A critical positive regulator of the SA signaling pathway in Arabidopsis is encoded by the NPR1 gene. However, there is growing evidence that NPR1-independent pathways can also activate PR expression and disease resistance. To elucidate the components associated with NPR1-independent defense signaling, we isolated a suppressor of the npr1-5 allele, designated ssi2. The recessive ssi2 mutation confers constitutive PR gene expression, spontaneous lesion formation, and enhanced resistance to Peronospora parasitica. In contrast, a subset of defense responses regulated by the jasmonic acid (JA) signaling pathway, including expression of the defensin gene PDF1.2 and resistance to Botrytis cinerea, is impaired in ssi2 plants. With the use of a map-based approach, the SSI2 gene was cloned and shown to encode a stearoyl-ACP desaturase (S-ACP DES). S-ACP DES is an archetypical member of a family of soluble fatty acid (FA) desaturases; these enzymes play an important role in regulating the overall level of desaturated FAs in the cell. The activity of mutant S-ACP DES enzyme was reduced 10-fold, resulting in elevation of the 18:0 FA content in ssi2 plants. Because reduced S-ACP DES activity leads to the induction of certain defense responses and the inhibition of others, we propose that a FA-derived signal modulates crosstalk between different defense signaling pathways.

Volumetric MRI, pathological, and neuropsychological progression in hippocampal sclerosis

OBJECTIVE

To examine the relationships between age at onset and duration of seizure disorder with severity of hippocampal sclerosis (HS) and cognitive functioning in patients with HS and unilateral temporal lobe epilepsy.

METHODS

Twenty-six subjects had left temporal lobe seizure onset; 20 had right temporal onset. Measures were age at seizure onset, duration of seizure disorder divided by age (seizure duration), history of febrile convulsion (FC), ratio of the smaller hippocampal volume to the larger (HF) as determined by volumetric MRI, and pathologic HS grade.

RESULTS

Results showed that pathologic HS grade and HF were positively related to seizure duration, and negatively related to seizure onset. When subjects were divided into onset prior to age 10 versus later, subjects with earlier onset had higher mean pathologic HS grade and smaller (more asymmetric) mean HF. When subjects were divided into seizure duration <0.5 (i.e., less than half current lifetime) vs greater, subjects with seizure duration > or =0.5 had higher mean pathologic HS grade and lower mean HF. There was also evidence for earlier age at seizure onset and longer seizure duration being associated with worse performance on neuropsychological measures. FC was not related to either seizure duration or age at seizure onset, but patients with a history of FC showed higher pathologic HS grade and lower HF. A history of FC was not related to cognitive functioning.

CONCLUSIONS

Unilateral HS patients with earlier seizure onset and longer duration of epilepsy have more severe HS and greater hippocampal volume asymmetry. This suggests that HS may be a progressive disorder with risk for cognitive dysfunction.

Intrasacral meningocele with tethered cord syndrome

We present a 65 year old, relatively asymptomatic man, who was found to have an intrasacral meningocele with tethered cord syndrome on Magnetic Resonance Imaging (MRI). Incidental detection of this entity at such an old age is very unusual.

Relationship of flumazenil and glucose PET abnormalities to neocortical epilepsy surgery outcome

BACKGROUND

Cortical areas showing abnormal glucose metabolism and [(11)C]flumazenil (FMZ) binding are commonly seen on PET scans of patients with intractable partial epilepsy, but it is unclear whether these must be totally resected to achieve seizure control.

OBJECTIVE

To analyze whether the extent of cortex showing 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) or FMZ PET abnormalities correlates with the outcome of resective epilepsy surgery.

METHODS

Cortical FDG and FMZ PET abnormalities in 15 young patients (mean age, 12.2 +/- 7.0 years) with intractable partial epilepsy of neocortical origin were marked as regions with abnormal asymmetry using an objective semiautomated software package. These marked regions were then projected and measured on the brain surface reconstructed from the coregistered high-resolution MRI. Following cortical resection, the size of nonresected cortex with preoperative PET abnormalities was also measured (calculated separately for marked areas in the lobe of seizure onset as defined by long-term video EEG monitoring, and in remote cortical areas). Extent of preoperative PET abnormalities and postoperative nonresected cortex abnormalities on PET were correlated with outcome scores.

RESULTS

Large preoperative FMZ PET abnormalities were associated with poor outcome (r = 0.57; p = 0.025). Larger areas of nonresected cortex with preoperative FMZ PET abnormalities in the lobe of seizure onset were also associated with worse outcome in the whole group (r = 0.66; p = 0.007) as well as in patients with extratemporal resection (r = 0.73; p = 0.007), and in those with no lesion on MRI (r = 0.60; p = 0.049). Patients with seizure-free outcome had significantly smaller nonresected cortex with preoperative FMZ PET abnormalities than those who continued to have seizures (p = 0.022). No significant correlations between nonresected FDG PET abnormalities and surgical outcome were found.

CONCLUSIONS

Extensive cortical abnormalities on FMZ PET predict poor outcome in neocortical epilepsy surgery. Resection of FMZ abnormalities in the lobe of seizure onset is associated with excellent outcome even in the absence of a structural lesion. In contrast, although FDG PET abnormalities regionalized the epileptogenic area, their size was not related to the extent of epileptogenic tissue to be removed.

Many-body and correlation effects in semiconductors

Solids consist of 1022-1023 particles per cubic centimetre, interacting through infinite-range Coulomb interactions. The linear response of a solid to a weak external perturbation is well described by the concept of non-interacting 'quasiparticles' first introduced by Landau. But interactions between quasiparticles can be substantial in dense systems. For example, studies over the past decade have shown that Coulomb correlations between quasiparticles dominate the nonlinear optical response of semiconductors, in marked contrast to the behaviour of atomic systems. These Coulomb correlations and other many-body interactions are important not only for semiconductors, but also for all condensed-matter systems.

Regulatory concerns and appraisal efficiency: the general impact of promotion and prevention

It was hypothesized that people's appraisals both of themselves and of other objects in the world are more efficient when the emotional dimension underlying their appraisals fits their regulatory concerns. Regulatory focus theory distinguishes 2 such fundamental concerns: promotion concerns with accomplishment that relate to cheerfulness- and dejection-related emotions, and prevention concerns with security that relate to quiescence- and agitation-related emotions. Five studies found that individuals with stronger promotion concerns were faster in appraising how cheerful or dejected the object made them feel, whereas individuals with stronger prevention concerns were faster in appraising how quiescent or agitated the object made them feel. These greater appraisal efficiencies were found for both chronic and situationally induced promotion and prevention concerns and were independent of both the valence and the extremity of the appraisals.

Environmentally sensitive, SA-dependent defense responses in the cpr22 mutant of Arabidopsis

To investigate the signaling pathways through which defense responses are activated following pathogen infection, we have isolated and characterized the cpr22 mutant. This plant carries a semidominant, conditional lethal mutation that confers constitutive expression of the pathogenesis-related (PR) genes PR-1, PR-2, PR-5 and the defensin gene PDF1.2. cpr22 plants also display spontaneous lesion formation, elevated levels of salicylic acid (SA) and heightened resistance to Peronospora parasitica Emco5. The cpr22 locus was mapped to chromosome 2, approximately 2 cM telomeric to the AthB102 marker. By analyzing the progeny of crosses between cpr22 plants and either NahG transgenic plants or npr1 mutants, all of the cpr22-associated phenotypes except PDF1.2 expression were found to be SA dependent. However, the SA signal transducer NPR1 was required only for constitutive PR-1 expression. A cross between cpr22 and ndr1-1 mutants revealed that enhanced resistance to P. parasitica is mediated by an NDR1-dependent pathway, while the other cpr22-induced defenses are not. Crosses between either coi1-1 or etr1-1 mutants further demonstrated that constitutive PDF1.2 expression is mediated by a JA- and ethylene-dependent pathway. Based on these results, the cpr22 mutation appears to induce its associated phenotypes by activating NPR1-dependent and NPR1-independent branches of the SA pathway, as well as an ethylene/JA signaling pathway. Interestingly, the SA-dependent phenotypes, but not the SA-independent phenotypes, are suppressed when cpr22 mutants are grown under high humidity.

Arachnoiditis associated with arachnoid cyst formation and cord tethering following myelography: magnetic resonance features

The reported incidence of clinically significant arachnoiditis following oil-based contrast media myelography is approximately 1%. The incidence of arachnoiditis in the dorsal spine is even more rare. Acquired arachnoid cyst formation can occur with arachnoiditis of various aetiologies. A case is presented of a patient with chronic backache, radiculopathy, weakness and muscle wasting, who had undergone myelography with oil-based contrast media about 28 years ago. There was no history of spinal surgery, spinal canal stenosis, disc disease or trauma, all of which are known to increase the risk of arachnoiditis. Magnetic resonance imaging features are presented in this case of arachnoiditis with arachnoid cyst formation, and cord tethering.

Cystic lumbar nerve sheath tumours: MRI features in five patients

Intraspinal cystic lumbar nerve sheath tumours constitute an uncommon subset of tumours with distinct clinico-biological behaviour. The MRI findings in five such cases are presented. Four of these were cystic schwannomas and one was a cystic neurofibroma. The pathology, MRI findings and the differential diagnosis of these rare tumours are analysed.