Soft tissue amyloidoma of the extremities: report of a case and review of the literature.

Amyloidoma (tumoral amyloidosis) is defined as a solitary localized tumorlike deposit of amyloid, in the absence of systemic amyloidosis. Amyloidoma is the least common presentation of tissue amyloid deposition and may be of AL-type or AA-type. It has been reported in many anatomic sites including the respiratory, genitourinary, and gastrointestinal tracts, as well as internal viscera, the central nervous system, skin, breast, and soft tissues.

Guidelines on the use of intravenous immune globulin for hematologic conditions.

Canada's per capita use of intravenous immune globulin (IVIG) grew by approximately 115% between 1998 and 2006, making Canada one of the world's highest per capita users of IVIG. It is believed that most of this growth is attributable to off-label usage. To help ensure IVIG use is in keeping with an evidence-based approach to the practice of medicine, the National Advisory Committee on Blood and Blood Products of Canada (NAC) and Canadian Blood Services convened a panel of national experts to develop an evidence-based practice guideline on the use of IVIG for hematologic conditions.

Neuropsychiatric events at the time of diagnosis of systemic lupus erythematosus: an international inception cohort study.

Objective: To describe the prevalence, characteristics, attribution, and clinical significance of neuropsychiatric (NP) events in an international inception cohort of systemic lupus erythematosus (SLE) patients.

Methods: The study was conducted by the Systemic Lupus International Collaborating Clinics (SLICC). Patients were enrolled within 15 months of fulfilling the American College of Rheumatology (ACR) SLE classification criteria.

Artifacts and pitfalls in myocardial perfusion imaging.

Myocardial perfusion imaging (MPI) is an important imaging modality in the management of patients with cardiovascular disease. MPI plays a key role in diagnosing cardiovascular disease, establishing prognosis, assessing the effectiveness of therapy, and evaluating viability. However, MPI is a complex process, subject to a variety of artifacts and pitfalls, which may limit its clinical utility.

People with epilepsy are often perceived as violent.

This study explores the possibility that people with epilepsy are commonly and persistently perceived as potentially violent during and between seizures. In 1981 and again in 2006, we assessed responses to a questionnaire that includes vignettes and direct questions about violence in epilepsy. Groups sampled were medical and law students, physicians, child care workers, the general public, and people with epilepsy (n=271 in 1981 and n=388 in 2006).

Polyoma virus in pediatric renal transplantation.

Renal transplantation is the treatment of choice for children with end-stage renal disease. Patient survival and allograft survival have improved with better immunosuppressant regimes to reduce acute allograft rejection but post-transplant infections have been exacerbated. An emerging problematic virus in the past decade is the polyoma virus BKV.

Safety and immunogenicity of two formulations of a hexavalent diphtheria-tetanus-acellular pertussis-inactivated poliovirus-Haemophilus influenzae conjugate-hepatitis B vaccine in 15 to 18-month-old children.

Combination vaccines decrease the number of injections and improve parental satisfaction and vaccination schedule compliance. In a phase 1, randomized, partially-blinded, single-dose booster study, we evaluated two formulations of an investigational liquid hexavalent vaccine containing diphtheria, tetanus, acellular pertussis (5-component), inactivated poliovirus, Haemophilus influenzae b conjugate and hepatitis B surface antigen (DTaP-IPV-Hib-HBV) in 60 healthy toddlers, 15 to 18 months of age, who had been primed with three doses of a licensed pentavalent diphtheria, tetanus, acellular pertussis (5-component), inactivated poliovirus, Haemophilus influenzae b conjugate (DTaP-IPV//PRP-T) vaccine. The DTaP-IPV//PRP-T vaccine was used as a control in 30 subjects.

Safe and novel technique for peritoneal access in urologic laparoscopy without prior insufflation.

Background And Purpose: Access to the peritoneum for transperitoneal laparoscopic surgery can be achieved using a variety of techniques, each of which has advantages and disadvantages as well as risks of complications. The endoscopic threaded imaging port (EndoTIP) is a metal, reusable, threaded visual-access cannula that is inserted by rotational rather than axial force. When the technique was described initially, capnoperitoneum was obtained prior to trocar insertion.

Fetal and neonatal outcomes of diabetic pregnancies.

Objective: To estimate whether the incidences of adverse fetal and neonatal outcomes in infants of mothers with preexisting types 1 and 2 diabetes 1) differ from infants of nondiabetic mothers in Nova Scotia (NS); and 2) have changed between 1988 and 2002.

Methods: Population-based cohort study using the NS Atlee Perinatal Database, a well-validated source of standardized clinical information.

Results: A total of 516 infants of diabetic mothers and 150,589 infants of nondiabetic mothers from singleton pregnancies were studied.

Congenital placental-cerebral adhesion: an unusual case of amniotic band sequence. Case report.

Amniotic band sequence is a disruption sequence having a broad spectrum of clinical manifestations ranging from partial amputations to major craniofacial and limb-body wall defects. Most reported cases of placental-cerebral adhesion pertain to patients with severe craniofacial defects who were either stillborn or who died a few hours after birth. The authors present a case of a male infant born with a placental-cerebral adhesion through a cranial defect.

Study protocol: a double blind placebo controlled trial examining the effect of domperidone on the composition of breast milk [NCT00308334].

Background: Domperidone, a drug that enhances upper gastric motility, is an anti-dopaminergic medication that also elevates prolactin levels. It has been shown to safely increase the milk supply of lactating women. To date, researchers have analyzed the effects of domperidone on lactating woman with respect to the quantity of their milk production, adverse effects, and drug levels in the breast milk.

Meningeal involvement in Wegener's granulomatosis.

We describe a patient with Wegener's granulomatosis (WG) who developed neurological symptoms attributed to meningeal involvement. The diagnosis of WG was complicated by persistently negative antineutrophil cytoplasmic antibodies (ANCA) and lack of specificity in the histopathological findings from multiple anatomical sites. This rare neurological manifestation of WG was treated successfully with oral cyclophosphamide and the patient has continued remission for 3 years taking oral methotrexate.

The risks and benefits of being a young female adolescent standardised patient.

Objective: To follow the progress of young female adolescents, as risk-taking standardised patients (SPs), and to monitor for adverse affects that role-playing may have on the adolescents.

Methods: A prospective design was used in which 11 female adolescents, aged 13-15 years, were recruited from 2 schools. The adolescents were trained to portray risk-taking individuals with a medical condition and were interviewed with their SP mother by final-year medical students 1-3 times a month over 6-14 months.

Randomized trial of long-term follow-up for early-stage breast cancer: a comparison of family physician versus specialist care.

Purpose: Most women with breast cancer are diagnosed at an early stage and more than 80% will be long-term survivors. Routine follow-up marks the transition from intensive treatment to survivorship. It is usual practice for routine follow-up to take place in specialist clinics.

Expectant management for the treatment of small renal masses.

The incidence of small renal masses that are detected incidentally is increasing, particularly in patients who are in advanced age and with increased comorbidities. We review the available data on the nature and natural history of these small renal tumors, and observe that based on the limited available information, most of these lesions appear to grow slowly. We also review the currently available markers of tumor progression.

Things we have learned from tilapia islet xenotransplantation.

An islet xenotransplantation model has been developed using tilapia (Oreochromis niloticus) as the donors. Studies using this model for the treatment of experimental type 1 diabetes in mice have produced promising results including the maintenance of long-term normoglycemia and mammalian-like glucose tolerance profiles in islet graft recipients. Islet encapsulation has also provided a promising method for the prevention of graft rejection, and strains of transgenic tilapia expressing a [desThrB30] human insulin molecule have been produced.

Neuropsychiatric syndromes in patients with systemic lupus erythematosus and rheumatoid arthritis.

Objective: The cause of neurologic (N) and psychiatric (P) syndromes in patients with systemic lupus erythematosus (SLE) is mutifactorial and includes primary immunopathogenic mechanisms, nonspecific sequelae of chronic disease, and concurrent illnesses. We compared the prevalence, diversity, and clinical significance of NP syndromes in patients with SLE and rheumatoid arthritis (RA).

Methods: Fifty-three patients with SLE were matched by age and sex to 53 patients with RA attending ambulatory clinics in a single academic medical center.

Disclosure of research results to research participants: A pilot study of the needs and attitudes of adolescents and parents.

Background: Researchers have a moral responsibility to offer to return research results to participants, but the needs and attitudes of parents and adolescents with cancer in paediatric oncology regarding the issue are relatively unknown.

Objectives: To explore the needs of potential research participants or their guardians with respect to the offer of a return of research results.

Methods: A questionnaire was used in a focus group and in telephone interviews with eight adolescents and 12 parents of children with cancer.

The frequency of intractable seizures after stopping AEDs in seizure-free children with epilepsy.

Background: After 1 to 4 years, seizure-free children with epilepsy are encouraged to stop daily antiepileptic drug (AED) treatment. Approximately 70% are successful. The authors examined how often intractable epilepsy follows discontinuation of AED treatment in a population-based cohort of children with epilepsy.

Intravascular T-cell lymphoma with bowel involvement: case report and literature review.

Intravascular lymphoma (IVL) is a rare form of non-Hodgkin lymphoma characterized by massive proliferation of large, neoplastic cells in small- and medium-sized blood vessels. Most cases of IVL are of B-cell immunophenotype; fewer than 15 cases of T-cell IVL have been reported. A 23-year-old male presented with acute abdominal pain, fever, and tender lower abdomen.

Solitary trunk from the right ventricle with a cleft mitral valve simulating the trifoliate left valve of an atrioventricular septal defect with common atrioventricular junction.

We report a case of a true cleft in the anterior leaflet of the mitral valve. The cleft, however, is directed toward the ventricular septum, and the left ventricular papillary muscles have the same arrangement as seen in the setting of a common atrioventricular orifice. The atrioventricular septum is intact.

Parent-child interactions among children with juvenile fibromyalgia, arthritis, and healthy controls.

Parent-child interactions during pain-inducing exercise tasks among children (11-17 years old) with fibromyalgia, juvenile rheumatoid arthritis, and pain-free controls were examined and the contribution of parent-child interactions to disability was tested. Fifteen children in each of the three diagnostic groups and their parents completed 5-min exercise tasks and completed questionnaire measures of disability (Functional Disability Inventory) and coping (Pain Coping Questionnaire). There were few group differences in parent-child interactions.

Neuropsychiatric events in systemic lupus erythematosus: attribution and clinical significance.

Objective: To describe the range and attribution of neuropsychiatric (NP) disease in an unselected cohort of patients with systemic lupus erythematosus (SLE) and to examine the association with cumulative organ damage, medication use, and quality of life.

Methods: One hundred eleven patients with SLE in a single referral center were studied. NP syndromes were defined using the American College of Rheumatology (ACR) nomenclature and case definitions.