Thyroid tuberculosis with abnormal thyroid function--case report and review of the literature.

Objective: To report an extremely rare case of thyroid tuberculosis (TT) with abnormal thyroid function and to review the related literature.

Methods: We present the patient's history, clinical findings, laboratory test results, imaging examinations, cytological data, management, and follow-up. In addition, we perform a review of the previously published cases of TT and give special attention to those with hypothyroidism.

Reconstruction of a large nasal defect.

A 77-year-old man was referred for treatment of a biopsy-proven multirecurrence basal cell carcinoma on the dorsum of the nose. The lesion was removed and the resulting surgical defect involved the full thickness of the nasal skin leaving intact the underlying perichondrium and cartilages of the whole nasal dorsum including both sidewalls (Figure 1). The authors performed a reconstruction of a surgical defect greater than two-thirds of the nose using a single-staged bilateral Burow's wedge flap and a full-thickness skin graft from the glabella.

Medial canthal area reconstruction with horizontal advancement flap.

The medial canthal area is a common site for the development of skin cancer, the reconstruction of this area can be challenging for the dermatologic surgeon. The author describes the reconstruction of a defect measured about 1.5 × 1.

Fulminant hepatitis during self-medication with conjugated linoleic acid.

The present report describes a 63-year-old female who presented with fulminant hepatic failure requiring liver transplantation caused by a weight loss dietary supplement containing conjugated linoleic acid (CLA). Thorough investigation, including liver biopsy, revealed no other cause of hepatotoxicity. In the last few years, a considerable number of reports have been published on toxic hepatitis, associated with non-conventional products, attributed with weight-reducing properties.

Stress-induced intraventricular gradients in symptomatic athletes during upright exercise continuous wave Doppler echocardiography.

The development of significant intraventricular gradients (IVGs) during exercise has been described anecdotally in athletes. However, the prevalence and clinical effect of this observation are unclear. In addition, the most appropriate exercise technique (upright vs semisupine) for eliciting IVGs also remains unknown.

Efficacy of beta-blocker therapy in symptomatic athletes with exercise-induced intra-ventricular gradients.

Background: Upright exercise stress echocardiography (SE) induces significant intraventricular gradient (IVG) and systolic anterior motion (SAM) in a large proportion of symptomatic athletes, who may therefore benefit from a negative inotropic therapy.The purpose of the present study was to assess the effect of chronic oral β blocker therapy on the occurrence of exercise-induced IVG and mitral valve SAM, in symptomatic athletes.

Methods: We enrolled 35 symptomatic athletes (age = 23 ± 11 years) with IVG (>30 mmHg) during SE off therapy.

Diagnosis of insulinoma in a patient with hypoglycemia without obvious hyperinsulinemia.

Background: A 41-year-old Maltese woman with a 12-month history of severe, morning episodes of confusion, blurred vision and sweating was referred to a specialist center for evaluation of fasting hypoglycemia. She was not taking medication and did not report any prior personal or familial history of endocrinopathy or other relevant pathology.

Investigations: Measurement of plasma glucose, insulin, C-peptide, and beta-hydroxybutyrate concentrations during a prolonged supervised fast; sulfonylurea screen; CT, MRI scan and endoscopic ultrasonography of the pancreas; calcium stimulation test; surgical exploration and intra-operative ultrasonography of the pancreas.

Microcarcinoids associated with diversion colitis in a patient with Crohn's disease.

Diversion colitis is an iatrogenic disorder related to surgical diversion of the faecal stream from the colorectal mucosa, first described by Morson in 1972. Inflammation of the defunctioned mucosa seems to be related to deprivation of luminal nutrients, in particular short chain fatty acids. Histologic abnormalities include damage of the epithelium and reparative changes with crypt distortion and branching, a mixed acute and chronic inflammatory infiltrate with crypt abscesses and lymphoid hyperplasia, Paneth cell metaplasia and thickening of the muscularis mucosae.

Exercise-induced intra-ventricular gradients as a frequent potential cause of myocardial ischemia in cardiac syndrome X patients.

Background: The development of intra-ventricular gradients (IVG) during dobutamine or exercise stress is not infrequent, and can be associated to symptoms during stress. The purpose of this study was to assess the occurrence of IVG during exercise stress echocardiography in cardiac syndrome X patients.

Methods: We prospectively evaluated 91 patients (pts) mean aged 51 +/- 12 years (age ranged 20 to 75 years old), 44 of whom were women.

Should right ventricle dilatation during exercise have clinical implications in patients with chronic thromboembolic pulmonary hypertension? Case report.

We describe the case of a 30-year-old female patient with chronic thromboembolic pulmonary hypertension that has an excellent functional capacity under treatment with sildenafil. She did an exercise stress echocardiography that revealed marked right ventricular dilatation during exercise. This information was used for clinical decision and the authors discuss the potential utility of this echocardiographyc sign.

Acute hemodynamic effect of inhaled iloprost in pulmonary artery hypertension evaluated with echocardiography.

Doppler echocardiography is useful in the initial evaluation and long-term follow-up of patients with pulmonary artery hypertension. Aerosolised iloprost has been shown to reduce pulmonary pressure immediately after inhalation. We report the echocardiographic findings in a patient with severe pulmonary hypertension, before and after the inhalation of aerosolized iloprost.

Clinical significance of intraventricular gradient during effort in an adolescent karate player.

The authors report the case of a 16-year-old boy who practices karate, who underwent medical evaluation because of atypical chest discomfort, related to strenuous effort. The ECG and echocardiogram findings were normal. The young boy did a treadmill stress test which was positive for myocardial ischemia.

Aberrant gastric apomucin expression in ulcerative colitis and associated neoplasia.

Aim: To evaluated the presence of gastric metaplasia in colonic mucosa of patients with ulcerative colitis and its relationship with dysplasia/neoplasia.

Material And Methods: Ninety patients with UC were selected. The duration and the extent of disease were registered in all the cases.

Spontaneous isolated non-haemorrhagic thrombosis in a child with development venous anomaly: case report and review of the literature.

Introduction: The natural history of developmental venous anomalies (DVAs) is said to be relatively benign.

Case Report: We herein report the clinical case of a 9-year-old female child with sudden right hemiparesis. An ischaemic infarct secondary to an isolated spontaneous thrombosis of a DVA was diagnosed by brain magnetic resonance imaging, further confirmed by digital subtraction angiography.

Paediatric dissecting posterior cerebral aneurysms: report of two cases and review of the literature.

Introduction: Intracranial aneurysms in the paediatric population are uncommon, accounting for 2% to 6% of all aneurysms, and spontaneous arterial dissection is rarely reported as the cause of aneurysms in children, especially in the posterior cerebral artery.

Methods: Two cases of paediatric spontaneous posterior cerebral artery dissecting aneurysms are reported, one in a 33-month-old male child presenting with aneurysmal rupture and subarachnoid haemorrhage and the other in a 9-year-old boy with an unruptured aneurysm.

Results: The first child was successfully treated by endovascular parent vessel occlusion without neurological deficit and in the second a spontaneous thrombosis of the aneurysm and its parent artery occurred associated with hydrocephalus and a favourable outcome.

MR imaging features of brain stem hypoplasia in familial horizontal gaze palsy and scoliosis.

We report the case of a child with horizontal gaze palsy, pendular nystagmus, and discrete thoracolumbar scoliosis. MR imaging of the brain depicted pons hypoplasia with an absence of the facial colliculi, hypoplasia, butterfly configuration of the medulla, and the presence of a deep midline pontine cleft (split pons sign). These MR imaging findings suggest familial horizontal gaze palsy with progressive kyphoscoliosis, a rare congenital disorder.

Differential diagnosis of mesiotemporal lesions: case report of neurosyphilis.

We report a clinical and imaging case of suspected herpes simplex encephalitis subsequently diagnosed as neurosyphilis based on positive antibodies in the CSF. MRI of the brain showed cortical and subcortical lesions in the mesial temporal region, septal area, insula and cingulated gyrus of the right cerebral hemisphere. Neurosyphilis should be included in the differential diagnosis of mesial temporal region lesions on MRI.

C-reactive protein as a marker of ventilator-associated pneumonia resolution: a pilot study.

The aim of this study was to evaluate C-reactive protein (CRP) levels, body temperature and white cell count (WCC) after prescription of antibiotics in order to describe the clinical resolution of ventilator-associated pneumonia (VAP). A cohort of 47 VAP patients with microbiological confirmation of disease was assessed. CRP levels, body temperature and WCC were monitored daily.

Native valve endocarditis due to Pichia ohmeri.

Candida species can cause clinical manifestations in various organs of the cardiovascular system, i.e., the pericardium, myocardium, and endocardium, with endocarditis being the best-known clinical entity.

Neisseria meningitidis native valve endocarditis. A case report.

The so-called nonpathogenic neisseriae are common inhabitants of the upper respiratory tract in humans and are not usually regarded as pathogens. Neisseria meningitidis on the contrary may cause severe disease. These organisms are an uncommon cause of infective endocarditis.

Dural arteriovenous fistula associated with neoplastic dural sinus thrombosis: two cases.

Intracranial dural arteriovenous fistulae are direct arteriovenous shunts within the dura matter. We report two cases of arteriovenous fistulae upstream to a neoplastic dural sinus thrombosis. These cases add further support to the acquired etiology of dural arteriovenous fistulae and to the fact that venous hypertension is one of the most important precipitating factors.