Hypoattenuating periportal halo on CT in a patient population can occur in presence of a variety of diseases

Many pathologies can occur in the periportal space and manifest as fluid accumulation, visible in Computed tomography (CT) images as a circumferential region of low attenuation around the intrahepatic portal vessels, called periportal halo (PPH). This finding is associated with different types of hepatic and extra-hepatic disease in humans and remains a non-specific sign of unknown significance in veterinary literature. The aim of this study was to investigate the prevalence of PPH in a population of patients undergoing CT examination and to assess the presence of lesions related to hepatic and extra-hepatic disease in presence of PPH. CT studies including the cranial abdomen of dogs and cats performed over a 5-year period were retrospectively reviewed. The prevalence of PPH was 15% in dogs and 1% in cats. 143 animals were included and the halo was classified as mild, moderate and severe, respectively in 51%, 34% and 15% of animals. The halo distribution was generalized in 79 cases, localized along the second generation of portal branches in 63, and along the first generation only in one. Hepatic disease was present in 58/143 and extra-hepatic disease in 110/143 of the cases. Main cause of hepatic (36%) and extra-hepatic disease (68%) was neoplasia. Associations between halo grades and neoplasia revealed to be not statistically significant (p = 0.057). In 7% of animals the CT examination was otherwise unremarkable. PPH is a non-specific finding, occurring in presence of a variety of diseases in the examined patient population.

Appendiceal Intraluminal Gas: A CT Marker for Gangrenous Appendicitis

Introduction. This manuscript aims to investigate the amount of intraluminal gas in acute, nonperforated appendicitis identified on computed tomography (CT) in diagnosing gangrenous appendicitis. Methods. This is a retrospective observational, case-control study with consecutive data collected at a tertiary institution over a two-year period, of patients with CT-diagnosed acute appendicitis who subsequently went on for surgery within 48 hours. Patients who were less than 16 years old, who had an interval between CT and surgery of more than 48 hours, or with CT evidence of appendiceal perforation were excluded. Images were independently assessed by 3 radiologists for intraluminal gas, and the results were then correlated with reference standards obtained from surgical and histopathology reports for the diagnosis of nongangrenous versus gangrenous appendicitis. The sensitivity, specificity, and predictive values of CT intraluminal gas in gangrenous appendicitis were calculated. Results. Our study identified 93 patients with nonperforated acute appendicitis who underwent surgery within the stated timeframe. Intraluminal gas in the appendix was identified in 26 patients (28%), of which 54% had macroscopic and/or microscopic evidence of gangrenous appendicitis. This is in contrast to the subgroup of patients who did not have intraluminal gas (72%), of which only 33% had gangrenous appendicitis. The specificity of intraluminal gas for gangrenous appendicitis is 79%, with a negative predictive value of 86% and likelihood ratio of 1.85. Conclusion. In cases of established acute appendicitis, the presence of intraluminal gas is a moderately specific sign for gangrenous complication. This is worth reporting as it can help prognosticate and triage patients accordingly, for a timelier surgical management and a better outcome.

Lateral Medullary Infarction with Contralateral Segmental Dysesthesia and Ipsilateral Headache: A Case Report

Introduction: The medulla oblongata is the lowest segment of the brain stem, located adjacent to the spinal cord, with a complex anatomical structure. Thus, a small injury to the medulla oblongata can show complex clinical manifestations. Case Presentation: A patient experienced dysesthesia, which manifested as numbness in her right lower limb and decreased temperature sense, and dizziness 20 days before admission. The numbness worsened 1 week before admission, reaching the right thoracic (T) 12 dermatomes. Her thermoception below the T12 dermatomes decreased, and the degree of dizziness increased, accompanied by nausea and vomiting. Magnetic resonance imaging (MRI) of the neck, chest, and abdomen performed at a local hospital showed no abnormalities. MRI of the brain was performed after admission. One week after admission, she experienced a severe headache in the upper left periorbital area. The numbness extended to T4, and thermoception decreased below T4. Diagnosis: Lateral medullary infarction. Interventions: Anti-platelet aggregation and mitochondrial nutritional therapies were performed along with treatments for improving circulation and establishing collateral circulation. Outcomes: The intensity of limb numbness decreased, and the symptoms of headache and dizziness resolved. Conclusion: Lesions leading to segmental sensory disorders can occur in the medulla oblongata. Ipsilateral headaches with contralateral segmental paresthesia can be a specific sign of lateral medullary infarction.

Paediatric retropharyngeal abscess with potts spine — A rare case

Tubercular retropharyngeal abscess along with potts spine is very rare in children. As there is no specific sign and symptoms of tuberculosis are present and even if present can be masked by features of nretropharyngeal abscess these cases may have delay in diagnosis. Early diagnosis is important to start proper treatment and can prevent the disability and mortality. In this article we report a case where a child presented to our opd with complaint of right sided neck swelling, dysphagia and neck pain with restricted movement. Any symptoms or signs of tuberculosis were not present. Clinical examination and MRI of neck suggested this as a case of retropharyngeal abscess with cervical spine involvement. Intraoral surgical drainage of pus sent for CBNAAT examination and it revealed the diagnosis of tuberculosis. Antitubercular regimen was given for 12 months. During follow up his symptoms gradually improved and after 1 and 2 year follow up child was free from tuberculosis. So in conclusion we can say retropharyngeal abscess in child should be dealt promptly and in case of abcesses refractory to conventional medical treatment, high degree of suspicion of tuberculosis should have present especially in endemic countries in order to reduce morbidities and improve clinical outcome. Early diagnosis and treatment can improve the scenario significantly.

A comparison of spoken and signed lingua franca communication: the case of English as a lingua franca (ELF) and International Sign (IS)

This article explores similarities between English as a lingua franca (ELF) and International Sign (IS), two lingua franca phenomena which in the last decades have been subject to increasing, albeit independent, linguistic research. In contrast to spoken intercultural communication, in which English often represents a shared resource that speakers from different linguacultural backgrounds draw on, in the visual-gestural modality no specific sign language has yet gained such global reach. Instead, in many international contexts IS is used: a lingua franca that can be more or less conventionalized and that is not based on one particular sign language. IS use depends on the communicative situation, in which signers flexibly and creatively use different signs from natural sign languages as well as iconic elements and gestures. Despite overt formal differences between ELF and IS, when focusing on the actual communication process, rather than the forms that result from it, the two lingua franca phenomena share many similarities. In fact, both ELF and IS are variable communicative means that get situationally adapted by speakers and signers on the basis of different resources they have at their disposal. Similar discussions about the difficulty of conceptualizing ELF and IS, about the role of multilingual resources, and about interaction processes at play can thus be found in both ELF and IS literature. This insight opens up new possibilities for researchers in the two fields to mutually benefit from the study of lingua franca communication in the other modality, which prompts the need for a cross-modal collaboration between ELF and IS researchers.

Number in Sign Languages

In sign languages, just as in many spoken languages, number can be marked on nouns, pronouns, and verbs, and quantifiers are used to specify quantity within noun phrases. The chapter does not address the expression of grammatical number in one specific sign language, but rather describes patterns found in various sign languages, focusing on modality-independent and modality-specific properties of number marking. As for the former, nominal and verbal plurals are commonly realized by reduplication. As for number-marking strategies specific to visual–spatial languages, it is found that sign languages employ the two hands (e.g. lexical plurality), the signing space in front of the signer's body (e.g. plural marking on predicates), and specific reduplication types that are not attested in spoken languages (e.g. sideward reduplication of certain nouns). In addition, the choice of pluralization strategy is determined by modality-specific phonological features, and we are thus dealing with phonologically conditioned allomorphy.

Myopic Simple Hemorrhage Presenting as Radial Hemorrhage in Henle’s Fiber Layer

This case report describes a simple hemorrhage (SH) presenting as radial hemorrhage in Henle’s fiber layer (HFL) in a patient with high myopia. A 26-year-old girl with high myopia was referred to our center for sudden onset of decreased vision and a central scotoma in the right eye (OD). Best corrected visual acuity (BCVA) was 20/100 OD. Fundus examination showed a stellate intraretinal hemorrhage in the fovea of the OD. The hemorrhage was organized in a peculiar petaloid pattern with feathery distal edges, suggesting localization within the radially oriented HFL. The presence of both choroidal neovascularization and microvascular abnormalities consistent with macular telangiectasia type 2 (MacTel 2) were excluded. Based on these findings, a diagnosis of myopic SH was made. At 4-month follow-up BCVA OD spontaneously improved to 20/40, without any treatment been ever administered to the patient. Spectral-domain optical coherence tomography OD showed reabsorption of the hemorrhage and almost complete restoration of the foveal architecture. The intraretinal location and spread of the hemorrhage into the HFL in our patient are an unusual presentation of SH, which vividly highlights the anatomy of the fovea. Since fibers in HFL are quite delicate and loosely arranged, this layer is very susceptible to deposition of transudates, exudates, hemorrhage, and other products. Radial hemorrhage in HFL has been originally reported in 4 patients as complication of MacTel 2. It has been previously postulated that it may represent a characteristic finding in MacTel 2 that may develop as a result of microvascular abnormalities of the deep retinal capillary plexus. On the contrary, our data suggest that radial hemorrhage in the HFL does not represent a characteristic finding of MacTel 2, but must rather be considered a non-specific sign with multiple possible etiologies.

Assessing the utility of lymphocyte count to diagnose COVID-19

Background: COronaVirus Disease 2019 (COVID-19) can be challenging to diagnose, because symptoms are non-specific, clinical presentations are heterogeneous, and false negative tests can occur. Our objective was to assess the utility of lymphocyte count to differentiate COVID-19 from influenza or community-acquired pneumonia (CAP). Methods: We conducted a cohort study of adults hospitalized with COVID-19 or another respiratory infection (i.e., influenza, CAP) at seven hospitals in Ontario, Canada.The first available lymphocyte count during the hospitalization was used. Standard test characteristics for lymphocyte count (x109/L) were calculated (i.e., sensitivity, specificity, area under the receiver operating curve [AUC]). All analyses were conducting using R. Results: There were 869 hospitalizations for COVID-19, 669 for influenza, and 3009 for CAP. The mean age across the three groups was 67 and patients with pneumonia were older than those with influenza or COVID19, and approximately 46% were woman. The median lymphocyte count was nearly identical for the three groups of patients: 1.0 x109/L (interquartile range [IQR]:0.7,2.0) for COVID-19, 0.9 x109/L (IQR 0.6,1.0) for influenza, and 1.0 x109/L (IQR 0.6,2.0) for CAP. At a lymphocyte threshold of less than 2.0 x109/L, the sensitivity was 87% and the specificity was approximately 10%. As the lymphocyte threshold increased, the sensitivity of diagnosing COVID-19 increased while the specificity decreased. The AUC for lymphocyte count was approximately 50%. Interpretation: Lymphocyte count has poor diagnostic discrimination to differentiate between COVID-19 and other respiratory illnesses. The lymphopenia we consistently observed across the three illnesses in our study may reflect a non-specific sign of illness severity. However, lymphocyte count above 2.0 x109/L may be useful in ruling out COVID-19 (sensitivity = 87%).

Histopathologic Manifestations of Crohn Disease in Duodenal Endoscopy Biopsy: The Value of Different Patterns of Involvement of Brunner Glands

Crohn disease (CD) not uncommonly involves the upper gastrointestinal tract, usually gastric antrum and proximal duodenum. The most consistent histopathologic manifestations of CD in duodenal biopsies are mucosal erosion, focal active inflammation, and granulomas. Since CD is a transmural inflammation and since duodenal biopsy may include submucosal Brunner glands, we aimed to find if CD has any specific histopathologic manifestations in Brunner gland lobules and their ducts compared to other duodenal inflammatory lesions. We carried out a retrospective review study over 6 years retrieving duodenal biopsy specimens in CD patients. We compared duodenal specimens involved by CD with other inflammatory lesions, for example, ulcerative colitis (UC), Helicobacter pylori-associated gastritis, non-Helicobacter gastritis, Celiac sprue, infections, and drugs. We found focal active duodenitis and erosion in CD cases and non-CD cases. Granulomas were found in CD cases. Five cases of CD showed inflammatory and degenerative changes of Brunner glands. Focal patchy active inflammation of only portion of submucosal Brunner gland lobule, mucosal Brunner glands, and their ducts was solely found in CD cases. This focally enhanced inflammation of Brunner glands was not found in other lesions. Whether this phenomenon of focal active “lobulitis” and “ductitis” is a specific sign of duodenal CD compared to UC and other inflammatory lesions warrants verification. We encourage endoscopists to include submucosal Brunner lobules in their duodenal biopsy samples and pathologists to look for these patterns of involvement particularly in patients suspected of CD.