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An unusual case of a posterior fossa arachnoid cyst containing atypical fluid is described in a patient presenting with an isolated ipsilateral twelfth nerve paresis. Despite the chronicity of symptoms, surgical decompression resulted in a satisfactory functional recovery.
A case of pseudofungi in axillary lymph nodes is presented. They resembled septate hyphae and were stained with a periodic acid-Schiff stain. Gomori methenamine silver stain failed to stain them. Because of morphologic similarity to true septate fungi and positive staining with periodic acid-Schiff stain, these structures can be misinterpreted as septate hyphae forming true fungal organisms. Further studies, some of which included energy-dispersive x-ray elemental analysis and special stains, revealed that they were composed of iron, phosphorus, and calcium. The relationship of these pseudofungi to previously published cases and clues that enable one to make a correct diagnosis are described.
A 3-year-old boy who presented with signs of virilization had a Leydig cell tumor of the left testis that could not be detected by physical examination or by high resolution ultrasonography. His very small tumor was demonstrated by magnetic resonance imaging. The implications of adding this sensitive method of imaging to the evaluation of prepubertal virilization of presumed testicular etiology are discussed.
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To test that dreams are influenced by the pre-sleep waking emotional concerns of the sleeper and have an effect on waking adaptation, 20 depressed and 10 control subjects, who were all going through a divorce, were enrolled in a repeated measures study lasting 5 months. A Current Concerns test was administered on three occasions before nights when every REM period was interrupted to record recalled mental content. The degree of waking concern about the ex-spouse correlated significantly with the number of dreams in which the former partner appeared as a dream character. Those who were in remission at the follow-up evaluation had a higher percentage of well-developed dreams than those who remained depressed. Dreams of the former spouse reported by those in remission differed from those who remained depressed in the expression of dream affect and in the within-dream linkage among units of associated memory material. Dreams of the former spouse that are reported by those who are not in remission lack affect and connection to other memories.
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We report two opposite-sex siblings with the severe infantile form of nemaline myopathy; diagnoses were made on muscle biopsy. Neither parent showed clinical or electromyographic evidence of myopathy, and both had negative muscle biopsies. Autosomal recessive inheritance seems likely.
Acute retinal necrosis (ARN) is a visually devastating disease consisting of necrotizing retinitis in healthy patients. The retinitis usually begins in the midperiphery to periphery and may spread to the posterior pole. Milder cases of ARN involving the posterior pole have been described. However, these cases never progress to full-blown ARN and have relatively good visual outcomes. A case is reported of a young, white woman with ARN that originally presented in the posterior pole. Unlike mild cases, spread to the midperiphery and periphery ensued until full-blown ARN occurred. This disease may present not only as an acute mid-peripheral to peripheral retinitis, but it also must be considered in the differential diagnosis of patients with multifocal, punctate areas of retinitis in the posterior pole.
The occurence is reported of optic chiasma gliomas in a pair of identical twins, both with neurofibromatosis. One twin developed precocious puberty in the sixth year of life and was shown by cisternal computerized tomography to have a supersellar tumor, which proved to be a malignant glioma. The second twin had an abnormal growth spurt but not overt precocious puberty. Cisternal computerized tomography of the second twin revealed evidence of a similar, smaller tumor at the same site. The literature is reviewed and some possible genetic explanations discussed. This report also emphasises the importance of careful investigation of the second twin when a malignancy is found in one, irrespective of the site or type of the tumor.
Concurrent orbital pseudotumor and Crohn's disease, although rare, have been described. To the best of our knowledge, pseudotumor isolated to the lacrimal gland (dacryoadenitis) with concurrent Crohn's disease has never been reported. We present the clinical course and ultrasonographic and radiologic findings of an acute case of isolated bilateral lacrimal gland pseudotumor in a patient with Crohn's disease. The treatment and review of the literature are discussed.
With the advent of conservative management of ectopic gestation, several patients have had persistent trophoblastic tissue after their surgical procedure. In the past such patients required repeat laparoscopy or laparotomy and further conservative or radical surgery. However, the use of methotrexate with leukovorum rescue offers a new alternative in the management of patients with persistent trophoblastic tissue after conservative surgery. Two patients with persistent trophoblastic tissue were treated successfully with methotrexate and leukovorum rescue. The use of medical therapy in such patients avoids a second surgical procedure, is associated with few side effects and appears to be an acceptable management alternative.
We report a case of necrolytic migratory erythema in association with a neuroendocrine tumour producing predominantly insulin. As far as we know this has not been observed before.
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