CLINICAL CONFERENCE

PEDIATRICS ◽  
1958 ◽  
Vol 21 (4) ◽  
pp. 682-684
Author(s):  
William A. Silverman
Keyword(s):  
Cerebrospinal Fluid ◽  
Male Infant ◽  
Costal Margin ◽  
Routine Manner ◽  
Cytomegalic Inclusion Disease ◽  
Left Costal Margin ◽  
History Of ◽  
Funduscopic Examination ◽  
The Right ◽  
Uneventful Pregnancy

Dr. Silverman: I shall present the history of an infant who was admitted to our premature nursery on May 9, 1956. This Puerto Rican male infant was born during the thirty-sixth week of an uneventful pregnancy. An antenatal serologic test for syphilis was negative. Delivery was spontaneous. Birth weight was 1070 gm. Physical examination on admission to the nursery revealed the liver to be 1 cm below the right costal margin and the spleen was firm, 1 cm below the left costal margin. Nothing else worthy of comment was noted and the infant was managed in a routine manner. The immediate newborn period was entirely uneventful, specifically neither petechiae nor unusual degree of icterus were noted. The ocular fundi were examined, as a matter of routine, during the third and fifth weeks of life and they were described as normal. During the sixth week of life, when the infant weighed 2080 gm, it was suddenly noted that the abdomen was quite distended. Examination at this time disclosed marked hepatosplenomegaly, both organs were firm. Again neither icterus nor petechiae were noted. There appeared to be some difficulty in swallowing. Roentgenograms of the chest at this time were normal and of the skull revealed intracranial calcification which was displayed in a pattern that seemed to outline dilated lateral ventricles. Lumbar puncture yielded cerebrospinal fluid which was negative except for protein of 198 mg/100 ml. The urine and cerebrospinal fluid were examined for the cells characteristic of cytomegalic inclusion disease and none were found. Funduscopic examination at this time disclosed an area of chorioretinitis in the right eye. It was presumed at this time that the infant had toxoplasmosis.

scholarly journals Immuno-Electronmicroscopic Studies of Surface Antigens of Blood Elements

Blood ◽  
1969 ◽  
Vol 33 (4) ◽  
pp. 648-648
Author(s):  
Giorgio Tonietti ◽  
Giuseppe A. Andres ◽  
Lidia Accinni ◽  
Maria Purpura ◽  
Konrad C. Hsu
Keyword(s):  
Osmotic Fragility ◽  
Surface Antigens ◽  
Costal Margin ◽  
Red Cell ◽  
Left Costal Margin ◽  
History Of ◽  
Red Cell Count ◽  
The Right ◽  
Blood Elements ◽  
Antibody Coating

Abstract PART I Immuno-Electronmicroscopic Studies of Surface Antigens of Blood Elements. I. Autoantibody on Erythrocytes in Acute Hemolytic Anemia, by Tonietti et al. Page 179—Methods and Material: The top 6 lines on page 180 should be transposed to page 179 starting as the 3rd line under Source of Erythrocytes, and the section properly reading as follows: Source of Erythrocytes The patient (L.S.), a seven year old male, was studied at the Centro Nazionale Transfusione Sangue, C.R.I., in March 1967. His history of anemia dated back to May 1964. Physical examination showed a deeply jaundiced boy. On palpation of the abdomen, the liver was felt 2 cm. below the right costal margin and the spleen 3 cm. below the left costal margin. The superficial lymph nodes were minimally but definitely enlarged. Examination of the blood revealed a red cell count of 1.8 million, a total white count of 3,600 and a platelet count of 180,000 per cu. mm. Bilirubin was 4.9 mg./100 ml. and the osmotic fragility of the red blood cells was normal. The blood group was O CCDee. Etc. Antiglobulin Tests Direct agglutination tests performed with the patient’s erythrocytes and antiserum to human globulin and antiserum to human IgG were positive. Absorption of the antihuman globulin with pure IgG rendered the serum incapable of agglutinating the erythrocytes of the patient,6 thus showing that the antibody coating the erythrocytes was of the IgG class.

scholarly journals Herpes Simplex Encephalitis

2005 ◽  
Vol 32 (2) ◽  
pp. 246-247 ◽  
Author(s):  
Sean W. Taylor ◽  
Roger M. Smith ◽  
Giovanna Pari ◽  
Wendy Wobeser ◽  
John P. Rossiter ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Herpes Simplex ◽  
Brain Biopsy ◽  
Executive Dysfunction ◽  
Cortical Lesion ◽  
Low Density ◽  
Intravenous Acyclovir ◽  
History Of ◽  
Simplex Virus ◽  
The Right

A 28-year-old woman presented with a one day history of high fever and partial seizures with secondary generalization. This was preceded by a three week history of headache, ataxia, and fatigue. An initial computed tomogram head scan showed a low density mass lesion in the right frontal operculum without enhancement. On the next day, a repeat scan showed a new frontopolar, expansile, low density cortical lesion (Figure 1A) suggestive of encephalitis. Cerebrospinal fluid showed a pleocytosis of 311 mononuclear white blood cell count per μL and an elevated protein of 1.57 g/L. She received intravenous acyclovir and antibiotics. She remained febrile and became mute. A magnetic resonance (MR) scan under general anesthesia on her fourth hospital day showed frontal and perisylvian lesions with restricted diffusion (Figure 1B - D and Figure 2). A right frontal brain biopsy showed meningoencephalitis and immunohistochemical staining was positive for herpes simplex virus (HSV) antigen (Figure 3). Subsequently, HSV-1 DNA was demonstrated in both cerebrospinal fluid and brain tissue with polymerase chain amplification. She improved after a course of intravenous therapy with acyclovir with residual frontal lobe signs, including marked executive dysfunction, and her speech became normal.

scholarly journals Spontaneous cerebrospinal fluid otorrhea and pneumocephalus on the contralateral side of the previous cranial surgery

2020 ◽  
Vol 11 ◽  
pp. 245
Author(s):  
Keiichiro Ohara ◽  
Tohru Terao ◽  
Shotaro Michishita ◽  
Kunitomo Sato ◽  
Yuichi Sasaki ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Fluid Collection ◽  
Petrous Bone ◽  
Contralateral Side ◽  
Ct Imaging ◽  
Csf Leak ◽  
Cranial Surgery ◽  
Defect Site ◽  
History Of ◽  
The Right

Background: Cerebrospinal fluid (CSF) leaks and pneumocephalus commonly occur due to head trauma or surgical procedures. Spontaneous CSF (sCSF) leaks, however, occur without any clear etiology and are relatively uncommon. Case Description: An 84-year-old woman presented with the right-sided otorrhea. The patient had a history of a ventriculoperitoneal shunt placement following a subarachnoid hemorrhage treated by clip ligation of a left-sided ruptured cerebral aneurysm 7 years before presentation, with shunt catheter ligation after evidence of intraventricular pneumocephalus 6 years before presentation. At admission, computed tomography (CT) imaging of the head showed enlargement of the lateral ventricles, a right mastoid fluid collection, and a defect of the superior wall of the right petrous bone. We performed a right temporal craniotomy for the repair of the CSF leak. Intraoperatively, it was noted that temporal lobe parenchyma herniated into the mastoid air cells through lacerated dura and a partially defective tegmen mastoideum. The leak point was successfully obliterated with a pericranial graft and reinforced by a collagen sheet and fibrin glue. There was no recurrence of otorrhea postoperatively. Conclusion: This report presents a very unique case of a patient with a CSF leak and pneumocephalus occurring on the contralateral side of a previous cranial surgery. We accurately identified the defect site with CT imaging and repaired the CSF leak by temporal craniotomy. Awareness of the mechanisms by which sCSF leaks can be caused by aberrant arachnoid granulations is imperative for neurosurgeons.

scholarly journals A Patient With Optic Nerve Pit Maculopathy Successfully Treated With Juxtapapillary Laser Photocoagulation

2021 ◽  
Author(s):  
Homayoun Nikkhah ◽  
Iman Ansari ◽  
Kiana Hassanpour
Keyword(s):  
Optic Nerve ◽  
Optic Disc ◽  
Laser Photocoagulation ◽  
Systemic Hypertension ◽  
Serous Macular Detachment ◽  
Abnormal Finding ◽  
Macular Detachment ◽  
History Of ◽  
Funduscopic Examination ◽  
The Right

Optic disc pits are rare and congenital or acquired anomalies of the optic disc, usually remaining asymptomatic. However, serous macular detachment or optic disc maculopathy is the most common complication, causing significant visual deterioration, without a current consensus about treatment. A 55-year-old woman with a past medical history of diabetes mellitus and systemic hypertension was referred for an abnormal finding in the retina. The Corrected Distance Visual Acuity (CDVA) was 20/40 in the right eye and 20/30 in the left eye. Marcus-Gunn was negative and Slit-lamp biomicroscopy revealed no pathologic findings in both eyes. Funduscopic examination showed an excavation in the inferotemporal part of the Optic Nerve Head (ONH) with serous macular detachment extending to the optic disc. Based on clinical examination and paraclinical imaging fluorescein Angiogeraphy (FAG) Optical Coherence Tomography (OCT), optic pit maculopathy was diagnosed and the patient underwent Juxtapapillary Laser Photocoagulation (JLP). After 2 years of follow-up, there were anatomical and functional improvements.

scholarly journals A Rare Case of Spontaneous Pneumocephalus Associated with Nontraumatic Cerebrospinal Fluid Leak

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Murad Baba ◽  
Omer Tarar ◽  
Amer Syed
Keyword(s):  
Cerebrospinal Fluid ◽  
Idiopathic Intracranial Hypertension ◽  
Sphenoid Sinus ◽  
Rare Case ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Bony Defect ◽  
History Of ◽  
The Right ◽  
Fluid Leak

Introduction. Spontaneous nontraumatic pneumocephalus (PNC) and cerebrospinal fluid (CSF) leaks are both very uncommon conditions. We report a rare case of spontaneous pneumocephalus associated with CSF leak secondary to right sphenoid sinus bony defect without history of trauma.Case Description. 51-year-old Hispanic female with past medical history of hypertension and idiopathic intracranial hypertension (Pseudotumor Cerebri) presented to the emergency room complaining of headache and clear discharge from the right nostril. Physical examination was significant for right frontal sinus tenderness and clear discharge from right nostril. Computed Tomography (CT) scan of the brain showed moderate amount of extra-axial air within the right cerebral hemisphere indicative of pneumocephalus. CT scan of facial bones showed bony defect along the right sphenoid sinus with abnormal CSF collection. The patient was started on intravenous antibiotics for meningitis prophylaxis and subsequently underwent transsphenoidal repair of cerebrospinal fluid leak with abdominal fat graft. CSF rhinorrhea stopped completely after the surgery with near complete resolution of pneumocephalus before discharge.Conclusions. Early identification of pneumocephalus and surgical intervention can help decrease the morbidity and avoid possible complications. Idiopathic intracranial hypertension, although rare, can lead to CSF leak and pneumocepahlus.

P171 LAPAROSCOPIC REPAIR OF A GIANT MORGAGNI’S HERNIA PRESENTING WITH RESPIRATORY DISTRESS

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Spyridon Davakis ◽  
Athanasios Syllaios ◽  
Lysandros Karydakis ◽  
Natasha Hasemaki ◽  
Antonia Skotsimara ◽  
...  
Keyword(s):  
Laparoscopic Repair ◽  
Diagnostic Algorithm ◽  
Acute Onset ◽  
Costal Margin ◽  
Hernia Sac ◽  
Chest Examination ◽  
History Of ◽  
Morgagni’S Hernia ◽  
The Right

Abstract Background Morgagni hernias are a rare entity among diaphragmatic hernias, representing 2% of all cases. Although uncommon, it can be fatal if the diagnosis is missed. Foramen of Morgagni is a triangular space located between the muscular fibers of the xiphisternum and the costal margin fibers that insert on the central tendon of the hemidiaphragm. They usually present in childhood with respiratory symptomatology, and a majority of cases in adults are detected incidentally on chest radiographs. Aims/Scope To present an extremely rare case of acute dyspnea caused by a giant congenital Morgagni’s hernia, together with review the diagnostic algorithm and the role of surgical treatment. Results A 48-year-old caucasian male, previously healthy, was referred to our department with acute onset dyspnea and vague right-sided chest pain for the past 4 months. No history of chest or abdominal trauma was mentioned. Chest examination revealed bowel sounds and decreased air-entry in the right chest. The patient was offered a laparoscopic repair; at operation, jejunum, ileum, appendix, ascending and transverse colon to its distal two thirds with the associated omentum were found within the hernia sac. Hernia’s neck was bridged with a dynamesh IPOM mesh in a tension free manner. The patient is well and symptoms free at 1 year follow up. Conclusion Majority of Morgagni hernias are diagnosed late because patients are either asymptomatic or present with nonspecific gastrointestinal or respiratory symptoms. Controversy exists regarding operative approaches via either transabdominal route or transthoracic route. In our case, laparoscopic repair was offered with favorable outcome.

Spontaneous cerebrospinal fluid rhinorrhea associated with dysplastic optic discs and a basal encephalocele

1981 ◽  
Vol 54 (6) ◽  
pp. 807-810 ◽  
Author(s):  
Dennis E. Bullard ◽  
H. Alan Crockard ◽  
W. Ian McDonald
Keyword(s):  
Cerebrospinal Fluid ◽  
Recurrent Meningitis ◽  
Csf Rhinorrhea ◽  
Content Type ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Basal Encephalocele ◽  
History Of ◽  
Nasal Secretions ◽  
Funduscopic Examination ◽  
Optic Discs

✓ A 24-year-old man presented with a history of recurrent meningitis secondary to cerebrospinal fluid (CSF) rhinorrhea. The patient had bilateral optic disc dysplasia in association with a basal encephalocele, but had no midline facial anomalies. The syndrome is rare, and this is the first report of a patient with this disorder in the absence of facial or radiographic anomalies. The case serves to emphasize the importance of funduscopic examination in patients with spontaneous CSF rhinorrhea or recurrent meningitis, and stresses the value of Dextrostix examination of nasal secretions in the evaluation of suspected CSF rhinorrhea.

scholarly journals Transperitoneal Subcostal Access for Urologic Laparoscopy: Experience of a Large Chinese Center

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Lei Zhang ◽  
Dong Fang ◽  
Xuesong Li ◽  
Lin Yao ◽  
Gengyan Xiong ◽  
...  
Keyword(s):  
Success Rate ◽  
Complication Rate ◽  
Costal Margin ◽  
Left Costal Margin ◽  
Midclavicular Line ◽  
The Right

Objective. To present our experience of using transperitoneal subcostal access, Palmer’s point (3 cm below the left costal margin in the midclavicular line), and its right corresponding site, in urologic laparoscopy. Methods. We used Palmer’s point and the right corresponding site for initial access in 302 urologic surgeries (62 cases with prior surgeries). The record of these cases was reviewed. Results. Success rate of initial access is 99.4%, and complication rate of puncturing is only 3.4% with no serious complication. In the cases with prior surgeries, there were only two cases with access complication on the right side (minor laceration of liver). For people with BMI more than 30 kg/m2 (12, 3.9%), the success rate was also 100 percent. Conclusions. Palmer’s point and the corresponding right location are feasible, effective, and safe for initial access in urologic laparoscopic surgeries. This entry technique should be used routinely in urologic laparoscopic surgeries.

Z-line degradation and phagocytosis of sarcomeric fragments in myonecrosis

1983 ◽  
Vol 41 ◽  
pp. 790-791
Author(s):  
Melinda L. Estes ◽  
Samuel M. Chou
Keyword(s):  
Vastus Lateralis ◽  
Inflammatory Myopathy ◽  
Muscle Disease ◽  
White Female ◽  
Inflammatory Cell Infiltrate ◽  
Limb Weakness ◽  
Muscle Diseases ◽  
History Of ◽  
The Right ◽  
Mononuclear Inflammatory Cell

Many muscle diseases show common pathological features although their etiology is different. In primary muscle diseases a characteristic finding is myofiber necrosis. The mechanism of myonecrosis is unknown. Polymyositis is a primary muscle disease characterized by acute and subacute degeneration as well as regeneration of muscle fibers coupled with an inflammatory infiltrate. We present a case of polymyositis with unusual ultrastructural features indicative of the basic pathogenetic process involved in myonecrosis.The patient is a 63-year-old white female with a one history of proximal limb weakness, weight loss and fatigue. Examination revealed mild proximal weakness and diminished deep tendon reflexes. Her creatine kinase was 1800 mU/ml (normal < 140 mU/ml) and electromyography was consistent with an inflammatory myopathy which was verified by light microscopy on biopsy muscle. Ultrastructural study of necrotizing myofiber, from the right vastus lateralis, showed: (1) degradation of the Z-lines with preservation of the adjacent Abands including M-lines and H-bands, (Fig. 1), (2) fracture of the sarcomeres at the I-bands with disappearance of the Z-lines, (Fig. 2), (3) fragmented sarcomeres without I-bands, engulfed by invading phagocytes, (Fig. 3, a & b ), and (4) mononuclear inflammatory cell infiltrate in the endomysium.

Popliteal artery thrombosis secondary to a tibial osteochondroma

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 251-255 ◽  
Author(s):  
Gruber-Szydlo ◽  
Poreba ◽  
Belowska-Bien ◽  
Derkacz ◽  
Badowski ◽  
...  
Keyword(s):  
Case Report ◽  
Magnetic Resonance Angiography ◽  
Popliteal Artery ◽  
Doppler Ultrasonography ◽  
Histopathological Examination ◽  
Previous History ◽  
Plain Radiography ◽  
Artery Thrombosis ◽  
History Of ◽  
The Right

Popliteal artery thrombosis may present as a complication of an osteochondroma located in the vicinity of the knee joint. This is a case report of a 26-year-old man with symptoms of the right lower extremity ischaemia without a previous history of vascular disease or trauma. Plain radiography, magnetic resonance angiography and Doppler ultrasonography documented the presence of an osteochondrous structure of the proximal tibial metaphysis, which displaced and compressed the popliteal artery, causing its occlusion due to intraluminal thrombosis..The patient was operated and histopathological examination confirmed the diagnosis of osteochondroma.

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