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An endoaortic calcified mass, sometimes referred to as a "coral reef" aorta, is an unusual cause of distal leg microembolization. When discovered it is usually in the suprarenal aorta. We present an unusual case of infrarenal coral reef aorta with symptoms of distal atheroembolism. A review of the literature is also presented.
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Malignant tumors of the maxilla are rare. In addition to primary tumors metastatic disease has to be considered. Renal cell carcinomas, carcinomas of the breast, lung and adenocarcinomas are constituting the most frequent primary lesions for maxillary metastases. To the best of our knowledge, we present the first case of a mucinous sweat gland carcinoma metastasizing to the maxilla four years after primary diagnosis. Thirty-two months after resecting the hemimaxilla, there are no signs of local recurrence. Although skin tumors only rarely develop distant metastases, sweat gland carcinomas should be included in the differential diagnosis of tumors metastasizing to the maxilla.
Local swellings of the foot are a common presentation in rheumatological practice. In the following case report, an epidermoid cyst presenting with the typical features of monoarticular arthritis is described in a 27-year-old woman. The differential diagnosis of forefoot swelling is discussed, with particular emphasis on epidermoid cysts and monoarticular arthritis.
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Repetitive stimulation of the small myelinated and non-myelinated afferents of the common peroneal (c.p.) nerve evokes a long-lasting (20-25 min), naloxone-reversible inhibition of the sural-gastrocnemius reflex in the decerebrated and spinalized rabbit. Altering the number and frequency of stimuli applied to the c.p. nerve showed that this inhibition was dependent on temporal summation of afferent input from that nerve, and that the optimum frequency for producing the effect was between 2 and 10 Hz. Application of natural conditioning stimuli in and around the receptive field of the c.p. nerve showed that noxious, but not innocuous, mechanical and thermal stimuli could evoke long-lasting inhibition of the sural-gastrocnemius reflex. Thermal stimuli produced a biphasic change in the excitability of the reflex with facilitation followed by inhibition. The opioid antagonist naloxone (250 micrograms.kg-1) blocked all suppression resulting from these natural noxious stimuli. Chemical stimulation of the skin with mustard oil did not evoke naloxone-reversible inhibition of the reflex. These results indicate that intensely noxious stimuli can promote the release of opioid peptides in the spinal cord, and that one of the functions of these peptides may be to regulate the level of excitability in withdrawal reflex pathways.
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Autotomy, or self-mutilation of the foot following sciatic and saphenous nerve lesions, was examined in rats after pretreatment of the sciatic nerve with capsaicin. This pretreatment produced an alteration in autotomy behavior which resulted in the sparing of the medial side of the foot. The effect occurred following a long (12-week) pretreatment-test interval, but not after shorter (1- and 4-week) intervals. The effect also depended on the successive transecting of the saphenous and sciatic nerves. Sparing of the medial side of the foot occurred only when the saphenous nerve was transected at the time of the sciatic nerve treatment with capsaicin. Because the side of the foot innervated by the saphenous nerve was spared by treating the sciatic nerve with capsaicin, we suggest that capsaicin alters the course of autotomy by preventing collateral innervation of the saphenous region by the intact sciatic nerve during the pretreatment-test interval. The fact that this occurs only after a 12-week interval suggests that capsaicin's effect on collateral innervation is a gradual process that requires a long time to develop.