Comparisons of PCBs dechlorination occurrences in various contaminated sediments

A comparison was made of reductive dechlorination occurrences of polychlorinated biphenyls (PCBs) by microorganisms collected from contaminated sediments including Er-Jen River (Tainan, Taiwan), Hudson River (Ft. Edward, NY), Silver Lake (Pittsfield, MA) and Puget Sound (Washington State). Comparisons was made in terms of chromatographic data (referring to the biological activity, including microbial availability) and thermodynamic data (demonstrating the selectivity of anaerobic microorganisms in the dechlorination of chlorinated compounds). Chromatographic data was established in terms of difference in relative retention time (delta ln RRT) and thermodynamic data was estimated as heat of reaction (delta H(r)0). Both were calculated and correlated to occurrences of dechlorination reactions. Observed dechlorination reactions for individually introducing PCB congener had delta ln RRT levels measured as >0.47 (Er-Jen River), >0.29 (Hudson River), >0.36 (Silver Lake) and >0.45 (Puget Sound, for Aroclor 1254 dechlorination). Critical of delta H(r)0 and delta ln RRT values showed that Hudson River and Silver Lake microorganisms were capable of dechlorinating PCBs through reactions with larger H(r)0 value (lower levels of released energy) and smaller delta ln RRT value compared with those found in Er-Jen River and Puget Sound sediments. Differences in the critical delta ln RRT values of these sediments may be due to differences in their levels of PCB contamination.

Sequential MR studies of a patient with white matter disease presenting psychotic symptoms: ADEM versus single-episode MS

Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are both demyelinating white matter disorders. It is difficult to differentiate ADEM from single episode MS because of the similar clinical presentation, cerebral spinal fluid (CSF) analysis, histological finding and magnetic resonance image (MRI) appearance. We report an ADEM case with unusual clinical presentations of predominant psychiatric symptoms, and relatively long disease course. Initially, we were not able to distinguish it from single episode MS. By means of sequential MR images followed up 2 years and spectroscopy studies, and the dramatic clinical improvement after corticosteroid therapy, ADEM was diagnosed as the disease entity of this patient. In this case report we will present the MR findings of this patient and discuss the differentiation between the ADEM and MS.

Image evaluation of suprazygomatic masticator space lesions

In order to understand lesions involving the suprazygomatic masticator space (SZMS) demonstrated on computered tomography (CT) or magnetic resonance (MR) images, we collected 45 cases of lesions in SZMS. There were hematomas in 26 cases, tumors in 16 cases, and abscesses in 3 cases. The location of these lesions in compartments of the SZMS and adjacent structures was analyzed. Most commonly hematoma was found in the deep loose connective tissue (80.8%), followed by the superficial dense connective tissue (61.5%). Only 2 SZMS hematoma involved the superficial fat pad. Five patients had air accumulation in the SZMS, and all were in the deep fat pad and with maxillary sinus fracture. Of the sixteen cases which were tumors, 12 were extended from adjacent structures, and four were primary tumor. In cases of tumor, compartments of SZMS involved most frequently were temporal muscles (15 of 16 cases), followed by deep fat pad (8 of 16 cases). The connective tissue layer of SZMS is a communication pathway for superficial spread of infection, hematoma, or tumor invasion to or from the scalp and face. Compartments of deep fat pad and temporal muscle are also pathways for the spread of disease to or from the face, intracranium and orbit. The primary tumors in infratemporal fossa and SZMS are rare. Malignant tumors in SZMS usually come from surrounding spaces.

Percutaneous transluminal angioplasty as an adjunct to treat the carotid-cavernous fistula

We report a case of the direct carotid-cavernous fistula (CCF) with high-grade stenosis of the internal carotid artery (ICA) and treatment via the transarterial route after percutaneous transluminal angioplasty (PTA). A 46-year-old man was found to have a CCF after a motorcycle accident. Transarterial embolization was attempted, but it failed due to stenosis of the left cervical ICA. After the procedure of PTA for dilatation of the stenotic ICA, the fistula was successfully obliterated by detachable balloon subsequently. There were no complications or recurrence of the fistula at the three-year clinical follow up.

Endovascular embolization of carotid-cavernous fistula using the posterior communicating artery approach: a case report

We report a case of direct carotid-cavernous fistula complicated with occlusion of internal carotid artery (ICA) at attempted endovascular obliteration via ICA and subsequent successful embolization via the posterior communicating artery (PCoA) approach. After a thorough understanding of vascular anatomical alterations associated with initial technical failure with detachable balloons, a microcatheter was navigated to the fistula site via the vertebro-basilar-PCoA to the distal cavernous segment of the left ICA. Embolization of the fistula was performed with deposition of three platinum microcoils. Angiograms after embolization showed complete disappearance of the fistula. There was no procedural complication and no recurrence of fistula at one-year clinical follow up.

Pneumocephalus secondary to septic thrombosis of the superior sagittal sinus: report of a case

Pneumocephalus secondary to septic superior sagittal sinus thrombosis (SSSST) is extremely rare. We report computed tomography (CT) findings in a 63-year-old man with SSSST caused by the gas-forming organism Klebsiella pneumoniae. The patient presented with fever, chills, general weakness, and spontaneous progressive swelling of the right frontoparietal scalp. CT revealed a gas-containing abscess over the right frontoparietal subgaleal region and in the superior sagittal sinus. Surgical drainage of the subgaleal abscess was performed and blood and pus cultures grew Klebsiella pneumoniae. The patient died of sepsis on the 6th day of hospitalization.

Inadvertent knotting of a thoracic epidural catheter

We report a case of corrosive injury of upper gastrointestinal and respiratory tracts scheduled for feeding jejunostomy under thoracic epidural anesthesia. An epidural catheter was inserted at the T8-T9 intervertebral space and threaded 7 cm beyond the tip of the Tuohy needle in a rostral direction. Resistance was noticed during attempts to inject the local anesthetic. As resistance could not be relieved by changing the position of the patient, kinking of the epidural catheter was suspected. Following informing the patient of the associated risks, the catheter was retrieved successfully by gentle and steady pulling. A tight double-knot of catheter was found. No neurological sequelae to the procedure were noticed.

Aneurysms of the fenestrated basilar artery treated with Gulielmi Detachabe Coils: case report

Multiple aneurysms at the site of a basilar artery fenestration (BAF) are extremely rare. We report a case of BAF in association with two aneurysms successfully treated with Guglielmi Detachable Coils (GDCs). A 42-year-old male presented with subarachnoid hemorrhage and consciousness change. Angiograms of the vertebrobasilar artery demonstrated fenestration of the proximal basilar artery associated with two aneurysms. Embolization of aneurysms was done by using GDCs. Aneurysms were almost completely obliterated with preservation of the flow and lumen of the vertebrobasilar system. The patient remains asymptomatic at clinical follow-up of 18 months.

Debt and other influences on career choices among surgical and primary care residents in a community-based hospital system

BACKGROUND

To evaluate debt and other factors that help formulate the career paths of future surgical and primary care physicians, a survey was undertaken.

METHODS

Surgical specialty (SS) and primary care (PC) residents were surveyed regarding demographics, factors influencing choice of specialty, methods of financing education, debt characteristics, and outlooks regarding future earnings and practice characteristics.

RESULTS

The clinical years of medical school and personalities of specialists and residents were important factors in career choices for both PC and SS. The length of residency, desirable lifestyle, and working hours were all more important to PC residents. Surgeons found intellectual challenge and procedure-based practice of greater importance. Although not highly regarded by either group, scholarship obligation and student loans had a significantly greater impact on specialty choice and practice plans for PC residents. At the completion of training, 55% of SS and 28% of PC residents anticipate owing more than $100,000. Debt was especially significant in specialty choice and practice plans for PC residents with debt over $100,000.

CONCLUSION

Surgical residents are less concerned about personal sacrifices in their quest to become surgeons. It appears state funded scholarships are successful in attracting students to primary care. Both SS and PC residents have significant debt, although, SS residents have greater financial debt than primary care residents. However, the anticipation of indebtedness was a more significant factor in determination of career path for PC.

Computed tomography and magnetic resonance imaging characteristics of giant pituitary adenomas

PURPOSE

The purpose of this study was to characterize the computed tomography (CT) and magnetic resonance (MR) imaging features of giant pituitary adenoma (GPA) and to demonstrate the pathways of the spread of GPA.

METHODS

CT and/or MR imaging scans of 356 patients evaluated preoperatively for single pituitary tumor were reviewed. Fourteen tumors (4%) fulfilled the radiologic criteria for GPA. There were 10 male and four female patients, ranging in age from 22 to 71 years (mean, 52 yr). We retrospectively reviewed the CT and MR imaging scans of these patients to characterize tumor appearances and identify the pathways of tumor extension.

RESULTS

Thirteen tumors (93%) extended upward to the suprasellar cistern, and/or hypothalamus and third ventricle. Infrasellar extension through the sellar floor and sphenoid sinus to the skull base, or to the ethmoid sinus or the nasopharynx, was identified in seven patients (50%). Eight patients (57%) had lateral invasion to the cavernous sinus. Temporal and frontal extension was apparent in seven patients (50%) and six patients (43%), respectively. Five patients (36%) had posterior subtentorial extension to the posterior fossa. Histologically, only two GPAs showed invasive features. There was no correlation among histologic features, pituitary hormone concentrations, and evidence of tumor aggressiveness on CT and MRI scans.

CONCLUSIONS

GPA has the potential for widespread, multi-directional extension. Our results indicate that any type of pituitary adenoma, regardless of its endocrinologic activity, may invade surrounding structures. Suprasellar invasion is the most common pathway of tumor spread, followed by infrasellar, lateral, anterior, and posterior routes.

Breech deformation complex in neonates

OBJECTIVE

To demonstrate the association of minor anomalies and breech-presenting newborns with breech deformation complex.

STUDY DESIGN

A total of 3,345 newborns with singleton, term delivery were examined based on a list of 67 items of major and minor anomalies. All infants were divided into two groups: group 1, vertex presentation (3,107 infants); group 2, breech presentation (224 infants). The prevalence of anomalies between both groups was compared.

RESULTS

There were 1,495 (44.9%) infants with one or more minor anomalies, which included 1,313 infants (42.3%) in group 1 and 182 (81.3%) in group 2 (P < .005). The prevalence of anomalies in groups 1 and 2 were: frontal bossing (1.8% vs. 51%), prominent occiput (0.8% vs. 42%), upward slant (11.6% vs. 23.7%) and low-set ears (0.3% vs. 20.5%). Torticollis (0.3% vs. 1.78%) and congenital dislocation of the hip (CDH) (0.06% vs. 0.9%) (all P < .005) were related to breech presentation.

CONCLUSION

Breech-presenting newborns had a higher risk of combining breech deformation complex, torticollis and CDH. The criteria for breech deformation complex included frontal bossing, prominent occiput, upward slant and low-set ears. The prevalence of breech deformation complex, torticollis and CDH was not related to the delivery method.