bluuebunny/crossref_metadata_2025 huggingface dataset:
Genetic Diversity, Aggressiveness and Metalaxyl Sensitivity of Pythium spinosum Infecting Cucumber in Oman
Authors: Al‐Sa’di A. M. , Drenth A. , Deadman M. L. , DeCock A. W. A. M. , Al‐Said F. A. , Aitken E. A. B.
Published: August 2010

A total of 24 isolates of Pythium spinosum from cucumber obtained from five regions in Oman were characterized for genetic diversity using amplified fragment length polymorphism (AFLP) fingerprinting and three isolates from the Netherlands, South Africa and Japan were included for comparison. Isolates from Oman were also characterized for aggressiveness on cucumber seedlings and sensitivity to metalaxyl. Identity of all isolates was confirmed using sequences of the internal transcribed spacer (ITS) region of the ribosomal DNA (rDNA), which showed more than 99% nucleotide similarity among all isolates. Using six primer‐pair combinations, AFLP fingerprinting resolved 295 AFLP markers of which 193 were polymorphic among isolates from other countries and only six were polymorphic among isolates of P. spinosum from Oman. Seven different AFLP phenotypes of P. spinosum were recovered in Oman; two of them were found to contain over 79% of isolates and one was recovered from all regions in Oman. Phenotypes from Oman showed very high (≥99%) levels of genetic similarity to each other compared to moderate (mean =53%) levels of genetic similarity with phenotypes from other countries. In addition, all isolates from Oman were found to be highly sensitive to metalaxyl and all were aggressive on cucumber seedlings at 25°C. The high genetic similarity among phenotypes of P. spinosum in Oman as well as recovering two major clones across regions may suggest that P. spinosum has been recently introduced in Oman via a common source.
Bilateral symmetric gluteal muscle metastases from pancreatic carcinoma presenting as a myositis
Authors: Agzarian MJ , Jones DN , Yong TY , Roberts‐Thomson P
Published: August 2010

Skeletal muscle metastases from pancreatic carcinoma are exceedingly rare with only a few cases reported in the published work. The case of a 59‐year‐old man with bilateral, symmetric gluteal muscle metastases from pancreatic carcinoma is presented. This case was clinically challenging as until skeletal muscle biopsy was carried out, the working diagnosis was that of paraneoplastic polymyositis. A brief review of the published work is also presented.
Unusual radiological appearance of a faecaloma
Authors: Sood BP , Rezai S , Parker D
Published: August 2010

Faecaloma is a hardened, relatively immobile, tumour‐like mass of accumulated faeces, usually found in the rectosigmoid region. Rarely, a faecaloma may be observed in other locations along the colon. It is a rare condition but has important complications, including ulceration, perforation and obstruction. The diagnosis is important not only to avoid confusion with neoplasm but also to alert the physician to the possibility of complications. Here we present a case of faecaloma, including the clinical and radiological difficulties in the diagnosis.
MRI of bilateral internal carotid artery agenesis
Authors: Welman CJ , Khangure MS
Published: August 2010

Bilateral internal carotid artery (ICA) agenesis is rare. A patient presented with symptoms of a transient ischaemic attack. Magnetic resonance imaging with magnetic resonance angiography showed multiple foci of chronic cerebral ischaemic change and bilaterally absent ICA. Cerebral supply was derived from the posterior circulation. Differentiation has to be made between congenital agenesis/hypoplasia and acquired ICA occlusion. Computed tomography through the skull base showed the absence of the carotid canals bilaterally confirming congenital ICA agenesis.
Massive occult haemoperitoneum following spontaneous rupture of duodenal gastrointestinal stromal tumour
Authors: Kan EYL , Wong LMK
Published: August 2010

Gastrointestinal stromal tumours are an uncommon subset of mesenchymal tumour that can occur anywhere along the gastrointestinal tract. Diagnosis of gastrointestinal stromal tumours is often difficult, as presentation is variable. This case report identifies massive haemoperitoneum as an initial finding, which is an unusual mode of presentation in gastrointestinal stromal tumours.
Urinary bladder paraganglioma in a case of von Hippel‐Lindau disease
Authors: Athyal RP , Al‐Khawari H , Arun N , Abul F , Patrick J
Published: August 2010

Pheochromocytoma is a well‐known association in patients with von Hippel‐Lindau disease. However, extra‐adrenal pheochromocytoma or paraganglioma with this association is rare. We describe a patient with von Hippel‐Lindau disease who presented with haematuria and was diagnosed to have a urinary bladder paraganglioma, which is an extremely rare tumour. Herein we report this case which, to the best of our knowledge, represents the first case highlighting the association of urinary bladder paraganglioma with von Hippel‐Lindau disease.
Basilar artery aneurysm treated with coil embolization via persistent primitive hypoglossal artery
Authors: Bapuraj JR , Ojili V , Khandelwal N , Shanbhogue AKP , Gupta SK
Published: August 2010

A saccular aneurysm at the basilar artery bifurcation associated with a persistent primitive hypoglossal artery (PPHA) was successfully treated by endovascular occlusion with Guglielmi detachable coils. As both vertebral arteries were aplasitc, a microcatheter was advanced via PPHA. To the best of our knowledge, this is the first case report describing the treatment of a basilar top aneurysm through the PPHA.
Dermatofibrosarcoma protuberans, magnetic resonance imaging and pathological correlation
Authors: Bergin P , Rezaei S , Lau Q , Coucher J
Published: August 2010

Dermatofibrosarcoma protuberans (DFSP) is a rare slow‐growing soft tissue tumour which characteristically occurs on the chest, head and neck regions. Typical histologic features include monomorphous spindle‐shaped cells arranged in a storiform pattern on a background of fibrous stroma. The tumour has a propensity for local invasion and high recurrence rate. While the imaging features are not pathognomonic of the tumour, the characteristic location and shape should prompt inclusion in the differential diagnostic list.
Intramural haematoma of the thoracic aorta: Rupture and endoluminal exclusion
Authors: Spencer AJ , Buckenham TM
Published: August 2010

Intramural haematoma is an increasingly recognized condition, characterized by an acute haemorrhage into the aortic wall without the creation of a pseudolumen. We present a case that was diagnosed by non‐contrast CT scanning, which showed a hitherto undescribed contained rupture into the mediastinum, but no haemothorax. This complicated intramural haematoma was then successfully treated with endoluminal exclusion, which was performed during frank rupture of the thoracic aorta into the left hemithorax which occurred just before the commencement of the endoluminal exclusion.
A case of late‐onset primary hyperoxaluria
Authors: Calisir C , Yavas US
Published: August 2010

Primary hyperoxaluria is a rare autosomal recessive disorder resulting in diffuse deposition of insoluble oxalate crystals in multiple organs. Two‐thirds of patients have nephrolithiasis by 5 years of age and 80% die of renal failure by 20 years of age. Rarely, the disease will present in adulthood, with the onset of symptoms occurring as late as the sixth decade. Oxalosis is a condition in which the highly insoluble calcium oxalate crystals are deposited in extrarenal tissue. Pathologic involvement of bone is recognized as osteosclerosis on radiograph. Oxalosis should be considered in patients with osteosclerotic bone changes and chronic renal failure and should not be misinterpreted as renal osteodystrophy. We describe here a case of oxalosis in a 33‐year‐old man.
Lemierre’s syndrome revisited: case report and imaging findings
Authors: Chiu O , Erbay SH , Bhadelia RA
Published: August 2010

Lemierre’s syndrome, characterized by infective thrombophlebitis of the internal jugular vein with septic emboli, was once a ubiquitous condition with high mortality rate in the pre‐antibiotic era. Radiological literature on this condition has been scanty in the era of cross‐sectional imaging. We present a 16‐year‐old patient with Lemierre’s syndrome with discussion of the typical clinical features and CT findings.
Pregnancy‐related spinal epidural capillary‐cavernous haemangioma: Magnetic resonance imaging and differential diagnosis
Authors: Hakan T , Demir MK , Aker FV , Berkman MZ
Published: August 2010

Epidural haemangiomas are very rare tumours of the spine. Only a few case reports have been published and most of them were cavernous or capillary. To the best of our knowledge, we report the first case of a histologically confirmed epidural capillary‐cavernous haemangioma of the thoracic spine presented in the MRI.
Disseminated peritoneal leiomyomatosis: magnetic resonance imaging and differential diagnosis
Authors: Demir MK
Published: August 2010

Disseminated peritoneal leiomyomatosis is a rare disease characterized by the presence of multiple myomatous nodules in peritoneal cavity. The diagnosis may be difficult in some cases as the results of ultrasonography and CT imaging may suggest malignancy. In this report, we describe the characteristic MRI findings of the disease with differential diagnosis in a 34‐year‐old woman discovered during laparoscopy for tubal ligation.
Omental torsion without a whirl sign
Authors: Ergun T , Lakadamyali H , Karabulut Z , Dogan T
Published: August 2010

Omental torsion is a very rare cause of acute abdomen. Its primary diagnostic modality is CT. The whirl sign visible in CT images is pathognomonic. The whirl sign is not present in all cases. When no whirl sign is seen, omental torsion is rather difficult to be differantieted radiologically from omental infarct and epiploic appendicitis. The diagnosis of these three entites is clinically important due to their different treatments. We present in this paper an omental torsion case where whirl sign was not present and diagnosis was made by other suggestive CT image findings.
Candida prosthetic valve endocarditis: the complementary role of multidetector computed tomography and transoesophageal echocardiography in preoperative evaluation
Authors: Ghersin E , Lessick J , Agmon Y , Engel A , Kophit A , Adler Z
Published: August 2010

A 72‐year‐old man with previous mitral valve replacement and single coronary bypass surgery was diagnosed with recurrent candida endocarditis by transoesophageal echocardiography and positive blood cultures. Preoperative electrocardiogram‐gated multidetector CT (MDCT) was ordered to evaluate the patency and course of the mammary graft. In addition to verifying graft patency, MDCT demonstrated a mobile vegetation on the mitral prosthesis as well as a vegetation on the posterior left atrial wall which was not visible by transoesophageal echocardiography. Multidetector CT also revealed signs of osteomyelitis in the thoracic spine. Repeated surgery confirmed these findings and mitral valve replacement with resection of the left atrial vegetation were performed. This case illustrates the complementary role of MDCT and echocardiography in the preoperative evaluation of fungal endocarditis.
Cystic splenosis mimicking a renal mass: a case report and review of the literature
Authors: Gürses B , Kabakçı N , Akşit HZ , Yencilek F , Kovanlikaya A , Kovanlikaya İ
Published: August 2010

Splenosis is a well‐known entity, caused by autotransplantation of splenic tissue as a result of trauma or splenectomy. Patients are generally asymptomatic, and this entity is diagnosed during routine diagnostic imaging. Cystic changes in splenic implants have been defined before but, as to our knowledge, radiological demonstration of cystic components has not been published in the literature. It is well‐known that unusual locations of the splenic implants create diagnostic problems, sometimes leading to unnecessary surgical interventions. In this report splenosis, mimicking a renal tumour, with cystic changes in the biggest splenule, and diagnosis with ferrumoxide‐enhanced MRI is presented.
Radiological and histological features of tumoral calcinosis of the dorsum of the foot
Authors: Kotajima S , Hatori M , Ogura K
Published: August 2010

Tumoral calcinosis is a rare condition characterized by large calcific masses occurring predominantly in the juxta‐articular regions of the extremities. To our knowledge, occurrences in the foot, particularly in association with bone erosion, have been very rare. A 52‐year‐old Japanese man presented with a mass in the foot, the size of which increased over a period of 27 years. CT scan and MRI demonstrated a 6 cm × 3 cm × 2.5 cm sized mass. There was bone erosion of the dorsal side of the third metatarsal head. Marginal excision was made. Histopathologically, the mass was composed of amorphous calcification with inflammatory cell infiltration. X‐ray diffraction method revealed that the pattern of the mass coincided with hydroxyapatite. The patients had no local recurrence at 5 years after operation.
Radiological features of progressive tumoral calcinosis in chronic renal failure
Authors: Hodnett P , Moore M , Kinsella S , Kelly D , Plant WD , Maher MM
Published: August 2010

We present the case of a young adult patient with chronic renal failure who developed painful subcutaneous nodules after failed renal transplant and recommencing dialysis. These nodules were juxta‐articular in location and initially located over both shoulders. Radiological evaluation suggested tumoral calcinosis. The patient was placed on a strict dialysis and dietary regimen but was suboptimally compliant with same. The patient developed progressive disease with an increase in size and number of juxta‐articular calcified soft‐tissue masses. However, 6 months following a second renal transplant clinical and radiological follow up demonstrated marked resolution both in symptomatology and radiographic findings. We present the plain radiographic, CT and MRI findings which demonstrate the typical radiological features of tumoral calcinosis. We correlate these findings with clinical course and histological findings following surgical excision of one of these masses.
Fibrolipomatous hamartoma of median nerve
Authors: Jain TP , Srivastava DN , Mittal R , Gamanagatti S
Published: August 2010

Fibrolipomaous hamartoma is a benign neoplasm of nerves, resulting from anomalous growth of fibroadipose tissue of the nerve sheath. The median nerve is the most commonly involved nerve. Magnetic resonance imaging (MRI) features are pathognomonic, showing a coaxial cable‐like appearance on axial images and spaghetti‐like appearance on coronal images. Preferred management of the lesion is conservative.
Ossifying pleomorphic adenoma of the parotid gland: A case report and review
Authors: Kato H , Kanematsu M , Ando K , Mizuta K , Ito Y , Hirose Y , Hoshi H
Published: August 2010

Pleomorphic adenoma is the most common parotid gland neoplasm and occasionally arises from the deep lobe of the parotid gland with extension into the parapharyngeal space. However, ossification of pleomorphic adenoma is rare, although chondroid and myxochondroid tissue formation is frequently seen histologically. We report an unusual case of ossifying pleomorphic adenoma arising from the deep lobe of the parotid gland in the parapharyngeal space.
Double superior vena cava with a persistent left superior vena cava: an incidental finding during peripherally inserted central catheter placement
Authors: Shyamkumar NK , Brown R
Published: August 2010

We describe a case of double superior vena cava with a persistent left‐sided superior vena cava discovered at the time of peripherally inserted central catheter (PICC) placement. The diagnosis was suggested by fluoroscopy and confirmed by venography. The relevance of the diagnosis with respect to PICC placement is discussed.
Usefulness of virtual colonoscopy in the diagnosis of symptomatic large colonic lipomas
Authors: Koktener A , Erden A
Published: August 2010

Lipomas of the colon are uncommon tumour of the gastrointestinal tract, but cause diagnostic difficulty when they are symptomatic. We reported two cases of symptomatic, large colonic lipoma. Colonoscopy was incomplete because of the narrowing lumen caused by lipomas. By the help of computed tomography colonography/virtual colonoscopy, colonic lipomas were diagnosed correctly, but also proximal colon was examined.
Multiple hepatic hemangiomas with fluid‐fluid levels
Authors: Lee J , Lim HK , Jeon YH
Published: August 2010

Hepatic haemangiomas with fluid‐fluid levels are known to be rare with only five cases reported in the English literature. According to the previous reports, the presence of fluid‐fluid level could attribute to the separation of blood cells and serous fluid because of the extremely slow flow in cavernous haemangioma of the liver. We describe the imaging features of multiple hepatic haemangiomas with fluid‐fluid levels, which was pathologically proven with ultrasonography guided biopsy.
Fluoromethylcholine PET in recurrent multifocal hepatoma
Authors: Lenzo NP , Anderson J , Campbell A , Morandeau L , De Grado TR
Published: August 2010

F‐18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has variable efficacy in evaluating hepatocellular carcinoma. We present a case of a new oncologic imaging tracer fluoromethylcholine (FCH), which has visualized recurrent multifocal hepatoma in a patient with a poor FDG avid hepatic tumour. The lesions demonstrated on FCH PET correlated well with the findings on CT hepatic angiography.
Case of fibromatosis of male breast
Authors: Li A , Lui CY , Ying M , Mak KL , Lam HS
Published: August 2010

Extra‐abdominal fibromatosis of the breast is rare with the clinical and radiological features closely resembled malignant breast tumour. We describe, in a 40‐year‐old Chinese male patient with a palpable left breast mass, the clinical, radiological and pathological features of this benign though locally aggressive tumour.
Iatrogenic stenosis following suture‐mediated closure device
Authors: Tam J , Given M , Lutjen P , Thomson K , Lyon S
Published: August 2010

The use of percutaneous closure devices post arterial punctures has been introduced to reduce time to haemostasis, reduce haemorrhage, improve patient comfort and reduce time to ambulation. Their increased use has been a result of larger access sites for more complicated procedures, periprocedural anticoagulation and concomitant use of anti‐platelet therapy. Although complication rates are not increased with their use as compared with mechanical compression, complications may be more severe and are an important consideration in their use. We report two cases of iatrogenic stenoses secondary to suture‐mediated closure device. The first managed with open surgical repair and the second with cutting balloon angioplasty.
Direct percutaneous portocaval shunt creation for haematemesis: Case Report
Authors: Pianta M , Tran N , Given M , Lyon SM
Published: August 2010

Creating a direct intrahepatic portocaval shunt (DIPS) is a procedure similar to a transjugular intrahepatic portosystemic shunt (TIPS) in patients for whom the latter is not appropriate due to unsuitable hepato‐venous and porto‐venous anatomy. We present a patient for whom TIPS was not possible, and DIPS successful.
Epidermoid cyst of the testis
Authors: Mak CW , Chen CY , Tzeng WS , Li C‐F
Published: August 2010

Epidermoid cysts, though having a variable sonographic appearance, may present with an onion peel configuration, that is, concentric rings of alternating hyperechogenicities and hypoechogenicities. The absence of vascular flow on colour Doppler sonography is also consistent with the avascular nature of these lesions. By combining these two sonographic features and the absence of biochemical tumour marker, preoperative diagnosis of epidermoid cyst is possible and may prompt a testis sparing surgery rather than orchidectomy.
Metastatic prostatic carcinoma mimicking a unilateral sacroiliitis
Authors: Manghani M , Loneragan R , Barnsley L
Published: August 2010

We describe a 65‐year‐old male who presented with unilateral sacroiliitis as the first manifestation of metastatic prostatic carcinoma. When progressive symptoms are unresponsive to conventional therapy, a reconsideration of the diagnosis is necessary with appropriate further imaging studies. We discuss the differential diagnosis of sacroiliitis including, mechanisms of joint involvement in malignancy, and present a review of the literature.
Thoracic splenosis: Diagnosis of a case based on history and computerized tomography findings
Authors: McKeen S , Dharsono F
Published: August 2010

Thoracic splenosis is an uncommon cause of multiple pleural‐based nodules. We present a case where a diagnosis of thoracic splenosis was made on the basis of radiologic findings and past history.
Appendiceal tie syndrome
Authors: Menon T , Martin RJ , Cameron D , Rao S
Published: August 2010

Intestinal knot syndromes such as ileosigmoid knots, ileal‐ileal knots have been described in the literature. We describe a case of a long inflamed appendix wrapping around a loop of ileum causing an appendico‐ileal knot, a rare form of closed loop obstruction with only five cases reported previously. The use of CT scanning prior to surgery is discussed and literature reviewed.
Myoepithelioma and malignant myoepithelioma arising from the salivary gland: computed tomography and magnetic resonance findings
Authors: Monzen Y , Fukushima N , Fukuhara T
Published: August 2010

We report the CT and MRI appearance of myoepithelioma and malignant myoepithelioma arising from accessory salivary glands of the soft palate and the submandibular gland. Correlation of the imaging features and histologic finding is presented. Radiologists should bear in mind that myoepithelioma and malignant myoepithelioma are included in radiological differential diagnosis of head and neck tumours.
Paradoxical cerebral arterial gas embolism: Computed tomography findings
Authors: Ghatge SB , Bhatgadde VL , Nagar AM , Raut AA , Narlawar RS
Published: August 2010

Computed tomography scan findings are described in cerebral arterial gas embolism in two patients with right to left intracardiac shunts by accidental injection of air during intravenous therapy. Although imaging may not be necessary to diagnose the condition, the patient may be referred to CT scan as a case of stroke. Cerebral arterial gas embolism should be considered in the differential diagnosis of stroke, particularly in case of right‐to‐left shunts. CT findings described are classical and diagnostic of the condition.
Axillary lump: an unusual presentation of fat necrosis in the breast
Authors: Donuru A , Obaid H , Al Attar M , Kandula V , Purnell D
Published: August 2010

The clinical presentation of an axillary lump, in majority of cases, raises suspicion of an enlarged lymph node due to malignant causes. In this case report, we established a diagnosis of an axillary lump caused by fat necrosis. We present this case report with review of the literature to familiarize clinicians with this condition.
Magnetic resonance imaging of a case of monomelic macrodystrophia lipomatosa
Authors: Pandey AK
Published: August 2010

Macrodystrophia lipomatosa is a rare form of non‐hereditary congenital localized gigantism. Radiographs and magnetic resonance imaging of one such case in a 3‐year‐old girl is presented in which the entire right‐lower limb was affected. Radiographs revealed excessive soft tissue hypertrophy and exostoses‐like bony overgrowth from the metatarsals. Magnetic resonance images showed excess unencapsulated fatty proliferation and fatty infiltration of the involved muscles.
Persistent trigeminal artery and associated vascular variations
Authors: Varghese SPJ
Published: August 2010

Persistent trigeminal artery (PTA) is the most frequent type of persistent primitive carotid‐basilar artery anastomoses. Persistent trigeminal artery is usually associated with small or absent posterior communicating artery (Pcom). It may also be associated with hypoplastic vertebral and basilar arteries. Patients may present with symptoms related to hypo‐perfusion of posterior circulation or microembolization from carotid artery to posterior circulation. We are presenting a 60‐year‐old who had recurrent episodes of vertigo and parasthesia, in whom MR angiography revealed a medial, Saltzman type 1 PTA on the left with absent ipsilateral Pcom, duplicated ipsilateral superior cerebellar artery, hypoplastic A1 segment of contralateral anterior cerebral artery (ACA), azygous ACA and hypoplastic ipsilateral vertebral artery.
Focal lesions on magnetic resonance imaging in aplastic anaemia: Multiple metastases or haemopoietic marrow
Authors: Gupta Gaurav , Robertson Patsy , Szer Jeffrey
Published: August 2010

We describe the imaging findings in the spine of a 26‐year‐old man with aplastic anaemia who is undergoing immunosuppressive therapy. Magnetic resonance imaging of the thoracolumbar spine revealed multiple focal low signal intensity lesions involving most of the thoracic and lumbar vertebral bodies. A CT‐guided biopsy of one of these lesions was performed at the level of L2, demonstrating normal haemopoietic tissue, with no evidence of lymphoma or metastases. Magnetic resonance imaging of bone marrow has been widely described previously, but few reports have examined the pattern of marrow regeneration following immunosuppressive therapy. The presence of low signal intensity lesions scattered through high signal intensity fatty marrow usually raises suspicion of pathology such as lymphoma, metastases or myeloma. In this case, the low signal intensity lesions represent regenerating, expanding haemopoietic marrow.
Dorsal dermal sinus with intramedullary abscess formation
Authors: Shah JR , Joshi V , Patkar D
Published: August 2010

Dorsal dermal sinus, a congenital abnormality associated with spinal dysraphism, can serve as a path for spread of infection inside the spinal thecal sac with its sequelae. Intramedullary abscess formation is an uncommon complication and only about 20 cases have been reported in the English literature. We report MR appearances of three new cases.
Cervical chordoma presenting as retropharyngeal mass and dysphonia: Case report and literature review
Authors: Singh N , Soo M , De Cruz M , Gomes L , Maclean F , Dandie G
Published: August 2010

Chordoma is a rare primary bone tumour that presents with signs and symptoms of local compression and myelopathy. A case of C4 chordoma with unusual clinical and imaging features is presented. The diagnosis of chordoma requires clinical, radiological and pathological correlation. Clinical features may include laryngeal symptoms arising from distortion of local anatomy. Characteristic tumour appearance and distribution on imaging plays a key role in diagnosis and management of this slow growing tumour with potential for major surgical morbidity.
Rare presentation of thyroglossal duct cyst after radiation therapy to the neck
Authors: Srinivasan A , Hayes M , Chepeha D , Mukherji SK
Published: August 2010

Thyroglossal duct cyst (TDC) is a congenital lesion which usually manifests as an enlarging painless neck mass in a child or young adult. We highlight an unusual presentation of TDC in an adult which developed after radiation therapy to the neck. We discuss the probable sequence of events and emphasize the need for radiologists, radiation oncologists and the surgeons to be aware of this entity when evaluating patients after radiation therapy.
Anterior urethral value: An uncommon cause of urethral obstruction
Authors: Hassam SMA , Tew K
Published: August 2010

An anterior urethral valve causing bladder outlet obstruction in children is rare. The early identification and management of this condition is crucial as delay may lead to chronic renal damage. We present a case of a 10‐month old male child diagnosed with an anterior urethral valve by micturating cystourethrogram. This case emphasizes the importance of visualizing the whole of the penile urethra in performing a paediatric MCU examination or this important diagnosis may be missed.
Pneumatosis intestinalis and portal‐venous gas: An unusual presentation of acute appendicitis
Authors: Tuite DJ , Byrne A , Colhoun E , Torreggiani WC
Published: August 2010

Pneumatosis Intestinalis in association with portal venous gas is a very rare finding in children and young adults. When present, it is typically associated with bowel infarction and carries a poor prognosis. We present an extremely unusual case where imaging revealed extensive pneumatosis intestinalis and portal venous gas in a patient with acute appendicitis.
Emergent treatment of an Iatrogenic arterial injury at femoral puncture site With Symbiot® self‐expanding PTFE‐covered coronary stent‐graft
Authors: Arat A , Turkbey B , Cil BE , Canyigit M , Cekirge S
Published: August 2010

We report an intracranial stenting procedure complicated by active bleeding from the femoral puncture site because of high arterial puncture. The patient was treated by placement of two PTFE‐covered self‐expanding coronary stent‐grafts. To our knowledge, there have been very few reports on stent‐grafting of femoral artery in the literature. The low profile and flexibility of the coronary stent‐graft enabled treatment via a six French sheath and 12th month patency is demonstrated with CT angiography.
Fluid‐calcium level in the thigh versus clinical diagnosis of a soft‐tissue abscess: Ultrasound features of dermatomyositis
Authors: Van Gelderen WFC
Published: August 2010

Ultrasound features of a fluid‐calcium level in a soft‐tissue mass in the thigh in dermatomyositis are described. As the mass was tender, a soft‐tissue abscess required to be excluded by aspiration.
Brain MRI features of merosin‐negative congenital muscular dystrophy
Authors: Ibrahim Abdulla JK , Vattoth S , Al Tawari AA , Pandey T , Abubacker S
Published: August 2010

The purpose of this article is to report brain MRI findings of merosin‐negative congenital muscular dystrophy (CMD) in two cases and to discuss its differentiation from other CMD subtypes. The cases were investigated by 1.5 Tesla MRI equipment using T1‐weighted, T2‐weighted, fluid‐attenuated inversion recovery (FLAIR), 3D fast spoiled gradient recalled (SPGR) and post‐contrast gadolinium enhanced sequences and the diagnosis was confirmed by muscle biopsy with immunohistochemical staining for merosin. Magnetic resonance imaging showed bilateral subcortical U‐fibre white matter changes with periventricular sparing in the first case. Though this imaging finding is non‐specific and could be seen in other white matter diseases like Canavan disease, the absence of other distinguishing MRI and clinical features of those conditions allowed a proper diagnosis. The second case showed diffuse subcortical and deep white matter involvement and cerebellar cysts. There was no brainstem involvement, polymicrogyria or cobblestone lissencephaly in both of our cases which allowed differentiation of merosin‐negative CMD from other CMDs. Muscle biopsy in both these patients showed dystrophic changes with absent staining for merosin confirming the diagnosis. Merosin‐negative CMD should be considered in the imaging differential diagnosis of white matter diseases. In a patient presenting with features of CMD, MRI can be of help in further differentiation of the various CMD subtypes.
Cervical surgical emphysema: Rare presentation of a sigmoid colon retroperitoneal perforation with abscess rupture through the lumbar triangle of Petit
Authors: Zentner L , Firkin A , House R
Published: August 2010

A retroperitoneal sigmoid colon perforation presenting with cervical surgical emphysema secondary to abscess rupture through the lumbar triangle of Petit into the posterior paraspinal muscle compartment has not been previously described. We report a case where previously ingested barium clearly demonstrates this unusual pathway.
Disturbance, species loss and compensation: Wildfire and grazing effects on the avian community and its food supply in the Serengeti Ecosystem, Tanzania
Authors: NKWABI A. K. , SINCLAIR A. R E. , METZGER K. L. , MDUMA S. A. R.
Published: August 2010

An important question in biodiversity studies is whether disturbances in ecosystems will cause a net loss of species or whether such losses can be compensated by replacement of other species. We use two natural disturbances, fire and grazing, to examine the response of bird and arthropod communities in grasslands of Serengeti, Tanzania. Both burning and grazing by migrant ungulates take place at the end of the rains in June–July. We documented the communities before disturbance, then 1, 4 and 20 weeks after disturbance on three replicate plots and compared them with three undisturbed plots. Birds were recorded by observation, arthropods from pitfall, tray trap and sweepnet samples. We expected that as the grass biomass was reduced by either disturbance, bird communities would change with concomitant change in arthropod food abundance. Alternatively, bird communities would change not with the absolute amount of food but with the greater accessibility of food as the grass structure changed from long to short grass. Results showed first that both bird species richness and abundance increased after both types of disturbance, but burnt sites showed a greater increase than that for grazed sites. Second, there was a change in bird species composition with disturbance. The functionally equivalent athi short‐toed lark (Calandrella athensis) was replaced by the red‐capped lark (Calandrella cinerea). Third, the abundance of most groups of arthropods was lower on disturbed sites than those on undisturbed sites, and the reduction of arthropod numbers was greatest on burnt sites. These results imply that bird abundance did not occur through an increase in arthropod abundance but rather through a change in the grass structure making food more accessible; and the higher predation could have caused the lower arthropod abundance. In addition, some bird species replaced others thus functionally compensating for their loss.
Evidence that a single exposure to aversive stimuli triggers long‐lasting effects in the hypothalamus‐pituitary‐adrenal axis that consolidate with time
Authors: Martí Octavi , García Arantxa , Vellès Astrid , Harbuz Michael S. , Armario Antonio
Published: August 2010

Because of its use as a negative reinforcer in animal studies and its potential pathological impact (e.g. post‐traumatic stress disorder and depression), exposure to aversive stimuli is a relevant model for studying CNS plasticity. We present evidence that a single exposure to two predominantly emotional stressors [restraint in tubes and immobilization on wooden boards (IMO)] can modify the response of the hypothalamo–pituitary–adrenal (HPA) axis to a subsequent exposure to the same stressor days later in that a more rapid return to the baseline was observed in the poststress period. In addition, the effect was greater with IMO, the more severe stressor. Using IMO, we have further demonstrated that the effect of a previous single exposure to the stressor (i) increased with days elapsed between the two exposures; (ii) was specific for the previously experienced stressor; and (iii) was mediated via central‐mediated effects [corticotropin‐releasing factor (CRF) mRNA in the paraventricular nucleus of the hypothalamus]. These data suggest that animals retain memory about a single experience with stressors, resulting in an acceleration of the poststress recovery of the HPA axis that enhances progressively over a period of weeks. The extent to which the present data are relevant regarding post‐traumatic stress disorders is unclear, but the study of the HPA response to severe stressors may be suitable for the study of the neurobiological basis of the progressive consolidation of learning over a long period of time (days to weeks).
TrkA‐expressing trigeminal sensory neurons display both neurochemical and structural plasticity despite a loss of p75NTR function: responses to normal and elevated levels of nerve growth factor
Authors: Krol Karmen M. , Stein Edward J. , Elliott Janet , Kawaja Michael D.
Published: August 2010

In neural crest‐derived sensory ganglia, approximately half of the neuronal population expresses the transmembrane trkA receptor that is required for neuronal binding of target‐derived nerve growth factor (NGF). These same neurons also express the p75 neurotrophin receptor (NTR) that increases the affinity of trkA for NGF. Depleting p75NTR expression reduces both the survival of trkA‐positive sensory neurons and their afferent innervation of peripheral targets. In this investigation, we assessed the neurochemical and structural plasticity of trigeminal sensory neurons in p75NTR‐deficient mice in response to either normal or elevated levels of NGF during postnatal development and into adulthood. Although p75NTR‐deficient mice have 30% fewer trigeminal neurons, levels of trkA mRNA expression are modestly elevated in these mutant mice as compared to control mice. The density of central afferent axons and local levels of NGF are, however, comparable between mutant and control animals. Thus, despite the survival of fewer trigeminal neurons, neither ganglionic levels of trkA mRNA expression nor the density of central afferent projections are depleted in p75NTR‐deficient mice. In response to elevated levels of NGF protein, transgenic mice with and without p75NTR expression display both increased levels of trkA mRNA expression and a greater density of trigeminal central afferent axons as compared to control mice. These data further reveal that an absence of p75NTR function in trigeminal sensory neurons does not diminish their capacity for NGF‐dependent plasticity, namely trkA mRNA expression and collateral growth of central afferent axons.
Astrocyte–endothelial cell calcium signals conveyed by two signalling pathways
Authors: Braet Katleen , Paemeleire Koen , D'herde Katharina , Sanderson Michael J. , Leybaert Luc
Published: August 2010

Astrocytes and endothelial cells are in close contact with each other at the blood–brain barrier, where important molecular transports take place. Despite these key morphological and functional properties, little is known regarding the dynamic signalling processes that occur between these two cell types. We investigated astrocyte–endothelial cell calcium signalling mechanisms in a coculture model prepared from primary rat cortical astrocytes and ECV304 cells. We used flash photolysis of caged inositol‐trisphosphate (IP3) and gentle mechanical stimulation to trigger astrocyte–endothelial cell calcium signals and to investigate the underlying propagation mechanisms. Photolytically releasing IP3in a single cell triggered increases in cytoplasmic calcium concentration that propagated between astrocytes and endothelial cells in either direction. These propagating calcium signals did not cross cell‐free zones and were not affected by fast superfusion or by the purinergic inhibitors apyrase and suramin, indicating that they are communicated through an intracellular pathway in conjunction with gap junctions. Electrophysiological experiments confirmed a low degree of astrocyte–endothelial cell electrical cell‐to‐cell coupling. Mechanical stimulation of a single cell also triggered astrocyte–endothelial cell calcium signals but, in contrast to the former triggering mode, these signals crossed cell‐free zones and were significantly inhibited by apyrase, thus indicating the involvement of an extracellular and purinergic messenger. Astrocyte–endothelial cell calcium signalling also occurred in cocultures prepared with astrocytes and primary rat brain capillary endothelial cells. We conclude that astrocytes and endothelial cells can exchange fast‐acting calcium signals (time scale of seconds) that can be communicated through an intracellular/gap junctional pathway and an extracellular purinergic pathway.
Prevention of galanin upregulation following neonatal infraorbital nerve transection or attenuation of axoplasmic transport does not rescue central vibrissae‐related patterns in the rat
Authors: Chiaia Nicolas L. , Shah Assad , Crissman Robert S. , Rhoades Robert W.
Published: August 2010

Neonatal transection of, or blockade of axoplasmic transport in, the infraorbital nerve [ION, the trigeminal (V) branch that supplies the mystacial vibrissae follicles] results in a loss of all central patterns corresponding to the vibrissae follicles in the brainstem, thalamus and cortex except for those of the central terminal arbors of ION primary afferents that survive this lesion. Both of these manipulations also result in a rapid and dramatic upregulation of at least two peptides, galanin and neuropeptide Y, in surviving vibrissae‐related primary afferents. Galanin is of particular interest, because this peptide has effects on neuronal activity and growth, both factors which may be involved in the disappearance of central vibrissae‐related patterns in rats that have sustained neonatal ION transection or axoplasmic transport blockade. The present study used antisense technology to determine whether the upregulation of galanin in the central terminals of ION primary afferents is necessary for the loss of central vibrissae‐related patterns in rats. Newborn rats had their left ION transected or axoplasmic transport in this nerve blocked by application of a vinblastine‐impregnated implant, and at the same time received an injection of commercially synthesized phosphorothioate oligodeoxynucleotide sequences (15–20 bases) directly into the V ganglion in order to block galanin upregulation. These injections effectively prevented the upregulation of this peptide which is normally associated with ION transection or axoplasmic transport blockade. Preventing galanin upregulation, however, did not prevent or attenuate the loss of central vibrissae‐related patterns in the brainstem or cortex normally observed following ION transection or axoplasmic transport blockade in this nerve. These results are thus consistent with the conclusion that the upregulation of galanin in the central terminals of V primary afferents, observed after damage to or attenuation of axoplasmic transport in the ION, is not necessary for the reorganization that results in a disappearance of central vibrissae‐related patterns in the V neuraxis.
Postoperative pain relief in infants undergoing myringotomy and tube placement: comparison of a novel regional anesthetic block to intranasal fentanyl – a pilot analysis
Authors: VORONOV POLINA , TOBIN MICHAEL J , BILLINGS KATHLEEN , COTÉ CHARLES J. , IYER ADITYA , SURESH SANTHANAM
Published: August 2010

Aim:  The aim of this study was to investigate the use of a novel regional anesthetic technique for the management of pain in the postoperative period in infants and children undergoing myringotomy and tube placement.

Methods:  After institutional review board (IRB) approval was obtained, 200 children were randomized in this double blind, prospective, randomized controlled trial to receive either a nerve block of the auricular branch of the Vagus (Nerve of Arnold) with 0.2 ml of 0.25% bupivacaine or receive intranasal fentanyl 2 mcg·kg−1 after induction of general anesthesia. Patients were monitored in the recovery room for analgesia, need for additional analgesia, incidence of nausea and vomiting, and time to discharge from the hospital. Additional analgesics administered in the PACU, surgical short‐stay unit as well as at home were also recorded.

Results:  There was no difference in the pain scores between groups (P = 0.53); there was no difference in the amount of rescue medications between groups (P = 0.86); there was no difference in the incidence of nausea and vomiting between groups (P = 0.34); there was no difference in the time to discharge between groups (P = 0.5).

Conclusions:  This pilot study demonstrates the efficacy of a peripheral nerve block for management of postoperative pain in infants and children undergoing myringotomy and tube placement. This may be a viable alternative for postoperative pain control in this population. Future multi‐center, randomized controlled trials may be necessary to validate the efficacy of this block in infants and children.
Perioperative cardiac arrests in children at a university teaching hospital of a developing country over 15 years
Authors: AHMED ALIYA , ALI MOHAMMAD , KHAN MUEENULLAH , KHAN FAUZIA
Published: August 2010

Objective/Aim: To study the incidence, causes, and outcome of perioperative cardiac arrests in children at a university teaching hospital with an aim of improving quality of care.

Background: Analysis of anesthesia‐related complications is routinely performed by most anesthesia departments to make prevention strategies.

Methods: All perioperative cardiac arrests in children up to 18 years from induction of anesthesia to postanesthesia care unit discharge or ICU admission during noncardiac surgery from January 1992 to December 2006 were analyzed. Outcome variable was noted as survival to discharge. Anesthesia‐related cardiac arrests were identified and their causes analyzed.

Results: Ten cardiac arrests occurred among 20216 patients. Overall incidence was 4.95 per 10000 (95% CI: 1.88–8.01). Six (6.53/10000) were females. Seven (19.44/10000) patients belonged to the classification III–IV of ASA physical status, eight (18.28/10000) were below 1 year, and two (1.26/10000) above 1 year. Three patients (6.53/10000) were undergoing emergency surgery. Anesthesia was primarily responsible in four cases. The causes of anesthesia‐related arrests were medication‐related (two), airway‐related (one), and under‐replacement of fluids (one). Seven patients died during the arrest and three were discharged home. The event was considered avoidable in seven (70%) cases.

Conclusion: Perioperative cardiac arrests were higher in patients with poor physical status, in those under 1 year of age, and in female patients. Anesthesia‐related cardiac arrests were mainly due to medication‐ or airway‐related causes. The majority of arrests were avoidable indicating the importance of prevention strategies.
Risk in pediatric anesthesia
Authors: Paterson Neil , Waterhouse Peter
Published: August 2010

Risk in pediatric anesthesia can be conveniently classified as minor or major. Major morbidity includes cardiac arrest, brain damage and death. Minor morbidity can be assessed by clinical audits with small patient samples. Major morbidity is rare. It is best assessed by very large clinical studies and by review of closed malpractice claims. Both minor and major morbidity occur most commonly in infants and children under three, especially those with severe co‐morbidities. Knowledge of risk profiles in pediatric anesthesia is a starting point for the reduction of risk.
Anesthetic management of congenital tracheoesophageal fistula
Authors: Broemling Natasha , Campbell Fiona
Published: August 2010

This article reviews (a) risk factors and preoperative considerations of the patient with tracheoesophageal fistula, (b) anesthetic management, including (i) airway management, (ii) induction of anesthesia and monitoring and (iii) postoperative disposition, (c) considerations for concomitant congenital heart disease, (d) considerations for thoracoscopic repair and (e) long‐term outcomes and considerations of the patient with repaired esophageal atresia/tracheoesophageal fistula.