Meningitis and spondylodiscitis due to Nocardia nova in an immunocompetent patient

BACKGROUND

Disseminated nocardiosis is a very rare disease. By now only few cases of meningitis and spondylodiscitis have been reported. To our knowledge, this is the first case of meningitis caused by Nocardia nova.

CASE PRESENTATION

We report on a case of bacteraemia, meningitis and spondylodiscitis caused by N. nova in an immunocompetent patient. We describe the long, difficult path to diagnosis, which took two months, including all diagnostic pitfalls. After nocardiosis was diagnosed, intravenous antibiotic therapy with ceftriaxone, later switched to imipenem/cilastatin and amikacin, led to rapid clinical improvement. Intravenous therapy was followed by oral consolidation with co-trimoxazole for 9 months without any relapse within 4 years.

CONCLUSIONS

Establishing a diagnosis of nocardiosis is a precondition for successful antibiotic therapy. This requires close communication between clinicians and laboratory staff about the suspicion of nocardiosis, than leading to prolonged cultures and specific laboratory methods, e.g. identification by 16S rDNA PCR.

Cerebral protection vs no cerebral protection: timing of stroke with CAS

Since its development in the late 1980s the discussion of risk and benefit of carotid artery stenting (CAS) compared to carotid endarterectomy (CEA) is still ongoing. In this discussion the increasing technical inventions in CAS like PDs, different stent designs and materials and their effect upon the complication rates are playing increasingly important roles. We present a review of mono- or oligocentre studies with greater collectives, one review study and multi centre studies SPACE I, EVA-3S and preliminary data from the ICSS-trial, in which subgroups of patients were treated with or without protection devices. Despite the results of several retrospective studies mostly with historic comparator cohorts rather than concurrent the results of the most recent multi centre prospective randomized trials seem to show a benefit for unprotected stenting. The complication rates for protected vs. unprotected groups in SPACE I showed 8.3% vs. 6.5% and the pooled data from SPACE I and EVA-3S 8.1% vs. 7.3%. A subgroup analysis of SPACE I aiming at the impact of the stent design on peri-interventional complication rate shows that the pOE rate was significantly lower in patients treated with a closed cell stent (5.7%, 95% CI: 3.7-8.3%) than in those treated with an open cell stent (11.0%, 95% CI: 6.2-17.8%) (P=0.047). The most recent data from prospective multi centre trials support the presumption that PDs do not reduce, but may increase the periinterventional complication rate. Whereas many older single centre studies promoting PDs do show conceptual problems. The stent design appears to have a more important impact on the resulting complications in CAS, than the PDs.

Dentomaxillofacial imaging in Proteus syndrome

Proteus syndrome is a rare condition that involves atypical growth of the bones, skin and head and a variety of other symptoms. Only a few authors have reported on the craniofacial manifestations so far. The authors present a case of a 7-year-old girl with Proteus syndrome in which the facial skeleton showed unilateral overgrowth. The analysis of the radiological evaluation revealed a bialveolar prognathism, a skeletal class III, a dolicocephalic growth pattern and a left convex face scoliosis. On the left side, the lesser wing of the sphenoid was elevated and the ethmoidal cell complex was hypertrophic. The left ramus and body of the mandible were enlarged. The asymmetric dental development with a precocious dental age on the affected side was the most striking feature on the panoramic view. Early diagnosis and therapy depend on clinical evaluation and imaging. Therefore, further evaluations on the craniofacial features of patients with Proteus syndrome are necessary in order to establish a list of characteristic symptoms.

A comparison of two intraoral CCD sensor systems in terms of image quality and interobserver agreement

PURPOSE

Two intraoral CCD sensor systems were compared with respect to image quality and interobserver agreement.

MATERIALS AND METHODS

Forty intraoral images from each of the sensors (Trophy RVG5, Sirona Sidexis) were examined by 4 observers in terms of anatomical landmarks and general image quality. The images were divided into 2 groups--filtered and unfiltered. Kappa values for interobserver agreement were calculated for all assessed points.

RESULTS

The Trophy sensor showed better image quality in the filtered group, and the Sirona sensor demonstrated good image quality in the unfiltered group. Moderate to substantial interobserver agreement was achieved. The use of filters increased edge artefacts. Sensor specific artefacts in the Trophy system were observed.