Ruptured Intercostal Artery Aneurysm with Radiculomedullary Branch Downstream Treated with Endovascular Stenting

Intercostal artery aneurysms are extremely rare, and could be associated with aortic coarctation, systemic diseases like neurofibromatosis, or more rarely Marfan syndrome. They could be life-threatening when ruptured, leading to hemothorax or mediastinal hematoma. Endovascular management before or after rupture of intercostal aneurysms, should be considered. Radiculomedullary branch, especially Adamkiewicz one, emanating from intercostal artery needs special focus during endovascular management, to avoid spinal cord ischemia. We present herein the first case of a ruptured intercostal artery aneurysm with a downstream Adamkiewicz artery in a suspected Marfan patient. Aneurysmal exclusion using stent graft was the unique therapeutic option.

18-FDG PSEUDOTUMORAL LESION WITH QUICK FLOWERING TO A TYPICAL LUNG CT COVID-19

As coronavirus pandemic continues to spread over the world, physicians have to be aware of atypical features of COVID-19 pneumonia. We report the case of a 78-year-old man presenting with pseudo-tumoral focal lesion of the left lung which switched shortly to severe and diffuse COVID-19 induced pneumonia. Nuclear medicine physicians and radiologists should be careful of some misleading hypermetabolic aspects mostly in asymptomatic patients.

[An abscessed granulomatous prostatitis]

INTRODUCTION

Prostatic abscesses are usually diagnosed in the setting of bacterial prostatitis. Rarely, they reveal or complicate granulomatous prostatitis.

CASE REPORT

A 55-year-old man was admitted for acute urinary retention. Urine culture was sterile, with leukocyturia > 10⁶/ml. After failure of antibiotic therapy with cefotaxime, CT scan revealed a necrotic prostatic collection and a nodular non-necrotic tissular lesion in the left upper lung lobe. Trans-rectal drainage of the prostatic lesion and lung biopsies revealed granuloma with multinucleated giant cells (without mycobacteria). The diagnosis of granulomatosis with polyangiitis was confirmed by high level of anti-proteinase 3 antibodies. Treatment with steroids and rituximab resulted in apyrexia, regression of the inflammatory syndrome and clinical manifestations.

CONCLUSION

The diagnosis of granulomatosis with polyangiitis should be considered in the presence of a non-infectious granulomatous prostatitis with systemic involvement.

DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) Mismatch in Thrombectomy Candidates: An Intrarater and Interrater Agreement Study

BACKGROUND AND PURPOSE

We aimed to study the intrarater and interrater agreement of clinicians attributing DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores) and DWI-FLAIR (Diffusion-Weighted Imaging-Fluid Attenuated Inversion Recovery) mismatch in patients with acute ischemic stroke referred for mechanical thrombectomy.

METHODS

Eighteen raters independently scored anonymized magnetic resonance imaging scans of 30 participants from a multicentre thrombectomy trial, in 2 different reading sessions. Agreement was measured using Fleiss κ and Cohen κ statistics.

RESULTS

Interrater agreement for DWI-ASPECTS was slight (κ=0.17 [0.14-0.21]). Four raters (22.2%) had a substantial (or higher) intrarater agreement. Dichotomization of the DWI-ASPECTS (0-5 versus 6-10 or 0-6 versus 7-10) increased the interrater agreement to a substantial level (κ=0.62 [0.48-0.75] and 0.68 [0.55-0.79], respectively) and more raters reached a substantial (or higher) intrarater agreement (17/18 raters [94.4%]). Interrater agreement for DWI-FLAIR mismatch was moderate (κ=0.43 [0.33-0.57]); 11 raters (61.1%) reached a substantial (or higher) intrarater agreement.

CONCLUSIONS

Agreement between clinicians assessing DWI-ASPECTS and DWI-FLAIR mismatch may not be sufficient to make repeatable clinical decisions in mechanical thrombectomy. The dichotomization of the DWI-ASPECTS (0-5 versus 0-6 or 0-6 versus 7-10) improved interrater and intrarater agreement, however, its relevance for patients selection for mechanical thrombectomy needs to be validated in a randomized trial.

[Vitamin B12 deficiency due to nitrous oxide use: unrecognized cause of combined spinal cord degeneration]

INTRODUCTION

Nitrous oxide is widely used in anesthesia. It is usually safe but may be associated with severe side effects when it is used repeatedly or on a prolonged time. Here, we report a case of drug-induced subacute combined spinal cord degeneration related to cobalamin deficiency.

CASE REPORT

A 20-year-old man with sickle-cell disease (SS) who was followed for severe recurrent vaso-occlusive crisis with repeated hospital admissions presented with ascending motor and sensitive neurological deficits that were later associated with bladder dysfunction. He was first considered to develop Guillain-Barre syndrome. However, persisting neurological signs despite adequate treatment lately led to diagnose subacute combined medullar degeneration due to abnormal cobalamin (vitamin B12) metabolism induced by repeated use of nitrous oxide during painful episodes of sickle-cell disease.

CONCLUSION

Inhaled nitric oxide is widely used in the treatment of vaso-occlusive crisis. Clinicians should be aware of possible severe neurologic side effects.

Heavy metals in water, sediment and tissues of Liza saliens from Esmoriz-Paramos lagoon, Portugal

Esmoriz-Paramos lagoon is an ecosystem of great ecological importance that is located on the northwest coast of Portugal and has been degraded as a result of industrial and anthropogenic activities. Concentrations of heavy metals (Cr, Cu, Pb and Zn) were measured in water, sediment and in tissues (liver and muscle) of Liza saliens, which is the dominant fish from the lagoon. Comparisons between metal concentrations in water and sediments were made with those in tissues of fish caught at the lagoon. Metals in water were quantified predominantly bound to particulate and equalled or exceeded the limit of chronic reference values. Metal concentrations in sediments varied among sampled sites. The relative order of concentrations was "Zn > Cu approximately Pb > Cr" the same pattern observed for metals in water. Metals in fish tissues showed higher concentrations in liver (262 mg CuxKg(-1) and 89 mg ZnxKg(-1)) than in muscle (<3 mg CuxKg(-1) and 26 mg ZnxKg(-1)), while Pb and Cr were not detected. These results suggest that Cu and Zn are the metals of major concern in the lagoon. Mullet detritivorous feeding habits, bioaccumulation pattern and the high sediment metals concentrations relative to the water suggest that sediments can be the most important source of contamination in this ecosystem. The positive relationship found between Cu in liver and fish length demonstrates that time of exposure is a crucial factor in bioaccumulation. Condition indices (K and HSI) in mullets from the lagoon were higher compared to mullets from sea, suggesting abnormal condition in the lagoon population. We conclude that metals chronic exposure in the lagoon can impose considerable fish stress. The results also show that the lagoon is an area of environmental concern.

Rose Dieback Caused by Trichothecium roseum in Argentina

Rose (Rosa sp.) is one of the most important ornamentals in Argentina. Since 2002, a severe disease has been observed on crops cultivated for cut flowers and garden plants in Escobar, San Pedro, Río Negro, and the surrounding area of Buenos Aires and La Plata. Symptoms consisted of a stem dieback progressing to plant death. In some cases, stem cankers were observed on the dieback limits. Mean incidence of stem dieback was 8% regardless of location. The disease was associated with pruning or harvest wounds. The objective of this study was to identify the causal agent of the described symptoms. Small pieces of diseased tissues from cvs. Rafaela, Merlise, Confeti, Mini rosal, Exótica, Macarena, and Peckowo were surfaced sterilized with a 2-min immersion in 0.2% NaOCl, washed with sterile distilled water, the tissue blotted dry, placed on 2% potato dextrose agar (PDA), and incubated at 22°C. Pure salmon-colored fungal colonies developed within 72 h. Hyaline, two-celled (the upper cell slightly larger), ovoid to ellipsoid conidia formed in chains at the apex of simple, long, slender, septate conidiophores. These characteristics are consistent with the description of Trichothecium roseum (Pers.) Link ex Gray (1) The pathogenicity tests were carried out on 10 plants of cv. Rafaela and 10 plants of cv. Mini Rosal using a conidial suspension (2.4 × 10⁵ spores/ml). All plants were pruned just before inoculation. Another 10 pruned plants (five from each cultivar) were sprayed with sterile water and served as controls. Inoculated and noninoculated plants were placed in a climatic chamber at 20°C and covered with polyethylene bags for 3 days to achieve a humid environment. Stem dieback was evident 7 days after inoculation on both cultivars and cankers appeared in 14 days. A dense, white mold that turned salmon-pink covered all the stems within 25 days. Inoculated plants died after 40 days. Symptoms did not develop on the control plants. The pathogen was recovered from inoculated stems, thus fulfilling Koch's postulates. To our knowledge, this is the first report of T. roseum causing a disease on rose in Argentina. Reference: (1) K. H. Domsch et al. Compendium of Soil Fungi. Academic Press. London, 1980.

A randomized controlled trial of mailed osteoporosis education to older adults

INTRODUCTION

Osteoporosis represents a growing public health concern; however, current rates of management are sub-optimal. The aim of our study was to assess, in a randomized controlled trial, the effect of a mailed educational intervention on older adults' knowledge, attitudes, and preventive behaviors regarding osteoporosis. The setting was a large publicly funded state pharmacy benefits program. The patients were 31,715 Medicare beneficiaries from Pennsylvania who participated in a drug benefits program for low-to-moderate income elderly people.

METHODS

All women aged over 65 years, and all men and women with a history of fracture or long-term oral use of glucocorticoid, were included. Approximately half of the participants (intervention group) were randomly selected to receive three mailings aimed at improving knowledge of osteoporosis and enhancing preventive activities, such as using calcium and vitamin D, reducing fall risks in the home, obtaining a bone mineral density (BMD) test, and taking medications when necessary. The other participants did not receive the intervention mailings and served as controls. We surveyed a sample of intervention and control subjects to determine the effects of the intervention on knowledge, attitudes, self-efficacy (confidence in one's ability to perform specific activities), and behavior regarding osteoporosis prevention and treatment. Six hundred randomly selected participants in the intervention group and an equal number in the control group were invited to participate.

RESULTS

Twenty-six had died and 636 of the remaining 1,185 (54%) completed the survey. Respondents and non-respondents did not differ significantly with respect to measured sociodemographic factors. All scales had good reliability (all Cronbach's alphas>0.65). Knowledge of osteoporosis was generally very good and did not differ between intervention (mean=65% correct responses) and control subjects (mean=67% correct; P=0.4). Perceived susceptibility to osteoporosis was relatively high and similar across groups (P=0.4). Self-efficacy for participating in osteoporosis prevention and treatment was very strong in both the intervention (mean=4.3 on a 0-5 scale) and control (mean=4.2, P=0.03) groups . On average, subjects in the intervention group reported participating in 3.5 of 6 preventive osteoporosis activities compared with 3.4 in the control group (P=0.5).

CONCLUSIONS

Compared with the controls, a mailed educational intervention for osteoporosis was not associated with better knowledge, higher perceived susceptibility, or performance of preventive measures among the at-risk older adults that we studied. The intervention group demonstrated a small increase in self-efficacy. More intensive patient interventions or intervention aimed at other aspects of the care process may be required to bring about changes that lead to a reduction in fractures.

[Fungal endophytes in Juncus imbricatus var chamissonis: identification of colonization patterns.]

Colonization patterns corresponding to individual endophytic species were observed in asymptomatic leaves and culms of Juncus imbricatus var chamissonis, a perennial plant. The presence of the fungi within the host was demonstrated by light microscopy after the cleaning and staining of tissues. The main endophytic species, Pleospora aff togwotiensis, was found colonizing the substomatal chamber and growing intercellularly between mesophyll cells. In a second colonization pattern, an unknown fungus was restricted to a single host epidermal cell, showing similar characteristics to other fungal taxa observed on Juncus effusus var pacificus, Pseudotsuga menziessii and Fagus sylvatica. A third colonization pattern, where the mycelium is confined to the substomatal chamber, was also described.

Rheumatoid factor positive, oligoarticular onset juvenile rheumatoid arthritis

We describe 2 children with oligoarticular onset juvenile rheumatoid arthritis (JRA) with early erosive disease. Both patients were rheumatoid factor (RF) positive, but neither had HLA-DR4. These findings suggest RF is associated with early erosive disease, independent of HLA-DR4. RF positive oligoarticular onset JRA should probably be recognized as a separate subgroup of JRA.

Intestinal pseudo-obstruction as an initial presentation of systemic sclerosis in two children

Two children are reported in whom intestinal pseudo-obstruction was the initial manifestation of systemic sclerosis. Gastrointestinal symptoms and skin changes resolved or improved in both children following treatment with prednisone and penicillamine (case 1) or methotrexate (case 2), although radiological changes of the gastrointestinal tract persisted at 3 and 2 yr of follow-up, respectively.

The incentive plan: an approach for modification of physician behavior

Blue Shield of Massachusetts undertook a one-year study in 1981 to determine if a group of obstetrician/gynecologists could be motivated to reduce average length of stay (ALOS) for normal deliveries, cesarean sections, and hysterectomies. The group decreased ALOS for all three procedures. Additional studies are required to determine what portion of the decrease in ALOS can be attributed to change in physician behavior.

RNA and DNA puffs in polytene chromosomes of rhynchosciara: inhibition by extirpation of prothorax

In the giant polytene chromosomes, gene amplification is made visible by formation of DNA puffs, and gene transcription is made visible by formation of RNA puffs. Ligation of the anterior portion of the larva at the end of the fourth larval instar inhibited the formation of the DNA puffs that normally develop at this stage and caused regression of RNA puffs.