1/89. Encapsulated necrosis associated with Behcet's syndrome.We reported a case of a 45-year-old woman with encapsulated necrosis associated with Behcet's syndrome. The lesions were characterized by multiple, small subcutaneous nodules on the extremities. Histologically, a nodule consisted of degenerative adipocytes encapsulated by fibrous tissue. A membranocystic lesion was also observed in the cavity of the nodule. The patient had a long-term history of Behcet's syndrome and suffered from erythematous subcutaneous nodules, resembling erythema nodosum on the extremities with a tendency to recurrence. These observations indicate that Behcet's syndrome could be implicated in the development of encapsulated necrosis as an underlying disease.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/89. Necrotizing pneumococcal pneumonia in childhood.We describe the rare complication of necrotizing pneumonia and invasive pneumococcal infection in 3 previously healthy pediatric patients. Lobar consolidation and pleural effusions appeared initially, followed within several days by the appearance of multiple small lucencies in the area of consolidation. In one case, necrosis progressed to a large abscess cavity. Surgical intervention was limited to treatment of pleural space complications. There were no deaths. Pulmonary parenchymal residual was limited to a thin-walled cavity in one case.- - - - - - - - - - ranking = 2keywords = cavity (Clic here for more details about this article) |
3/89. Metastasising malignant lymphoma mimicking necrotising and hyperplastic gingivostomatitis.This paper presents the case of a 65 year-old woman suffering from recurrent oral aphthoid ulcers which rapidly evolved towards hyperplastic and ulcerated lesions over the entire floor of the mouth. The initial lesions were interpreted as non-specific aphthoid ulcers. Later, a tentative diagnosis of necrotising stomatitis with secondary reactive proliferating epithelial hyperplasia was made. The clinical symptoms and the immuno-phenotyping of lymphocytes circulating in the peripheral blood suggested the diagnosis of CD30-positive large cell anaplastic lymphoma. The biopsy showed only a pseudoepitheliomatous hyperplasia, reactive infiltrates and no lymphoma cells. The disease ran a fulminant course leading to death within 4 weeks due to acute gastro-intestinal bleeding. autopsy revealed infiltrates of CD30 large cell anaplastic lymphoma in a submandibular lymph node, in a thrombus stenosing the right subclavian vein, in the spleen, the anterior and posterior gastric wall as well as in the depth of the tumour on the floor of the mouth. The clinical and histopathological spectrum of CD30 large cell anaplastic lymphoma is considerably variable. The particular feature of pseudoepitheliomatous hyperplasia has been reported especially in CD30 anaplastic large cell lymphomas. An early correct diagnosis is rendered difficult in insufficient biopsy size, becauses this type of lymphoma often simulates other inflammatory or neoplastic skin diseases. Thus, with a necrotising and hyperplastic gingivostomatitis, the diagnosis of a CD30 anaplastic large cell lymphoma should be considered.- - - - - - - - - - ranking = 0.34771767250943keywords = mouth (Clic here for more details about this article) |
4/89. mucormycosis of the nose and paranasal sinuses.Rhinocerebral mucormycosis is an invasive fungal infection initiated in the paranasal sinuses that frequently progresses to orbital and brain involvement. If recognized early, involvement is limited to the nasal cavity and paranasal sinuses. Diabetics in poor control are at greatest risk, however, any immunocompromised individual may be infected. The mainstays of therapy are reversal of immunosuppression, systemic amphortericin B, and surgical debridement. survival has improved dramatically, yet deaths still occur if the infection is not recognized and not treated early in its course or if the source of immunocompromise is not reversible. Several case examples illustrate the clinical course of this unusual, but potentially fatal, fungal infection. Taxonomy, clinical presentation, diagnosis, and management of mucormycosis of the paranasal sinuses are reviewed in detail.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
5/89. Descending necrotizing mediastinitis due to odontogenic infections.OBJECTIVE: Acute purulent mediastinitis caused by oropharyngeal infection is termed descending necrotizing mediastinitis. Such infections usually have a fulminate course, leading to sepsis and frequently to death. The purpose of this study is to show the importance of early diagnosis, aggressive surgical intervention, and optimal antibiotics chemotherapy in controlling this fatal infectious disease. STUDY DESIGN: Two patients with descending necrotizing mediastinitis due to odontogenic infection who were treated at our institution are described. RESULTS: Both patients survived. CONCLUSIONS: From the patients, 23 different aerobic and anaerobic bacteria were isolated. All of the isolates were susceptible to carbapenem. Early evaluation by means of cervicothoracic computed tomography scanning was extremely useful for diagnosis and surgical planning. knowledge of anatomic pathways from the mouth to the mediastinum is essential. We believe that tracheostomy is not always necessary. In both of the cases presented, mediastinal drainage was completed through use of a transcervical approach. However, a more aggressive drainage including tracheostomy might be necessary when the infection extends below the carina.- - - - - - - - - - ranking = 0.17385883625472keywords = mouth (Clic here for more details about this article) |
6/89. brain abscess formation in radiation necrosis of the temporal lobe following radiation therapy for nasopharyngeal carcinoma.BACKGROUND: radiation necrosis is a known complication following radiation therapy for extracranial as well as intracranial tumours. However, brain abscess formation in radiation necrosis has not been reported in the literature. We report the clinical data of 6 patients suffering from this condition. METHOD: Twenty-eight patients with radiation necrosis of the temporal lobe following radiotherapy for nasopharyngeal carcinoma were treated surgically at the Department of neurosurgery, Queen Elizabeth Hospital, hong kong between January 1992 and July 1999. Of these, 6 cases were complicated by brain abscess formation. The clinical data of these 6 patients are retrospectively reviewed. FINDINGS: The patients were 5 males and 1 female, ranging in age from 41 to 67 years. Three patients had previous treatment with steroids for the symptomatic radiation necrosis. A history of nasal infection or otitis media was recognised in all 6 patients. All patients were treated surgically by temporal lobectomy and excision of the necrotic tissue together with the abscess cavity. Intra-operatively, a bony defect was observed between the middle cranial fossa and the sphenoid sinus in 3 patients and the bony defect was repaired with a temporalis muscle flap. The species of organisms could only be identified in 3 patients. In 3 patients, the pus smear was positive but the culture was negative. Subsequently, 4 patients recovered and 2 patients died. INTERPRETATION: Cerebral radiation necrosis is a predisposing cause of brain abscess formation. Surgical excision is recommended as the treatment of choice in this group of patients.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
7/89. Arthrodiatasis for chondrolysis with hinge abduction: a case report.A 13-year-old boy with bilateral chronic slipped capital femoral epiphysis was referred to the Nagoya University Hospital. Chondrolysis occurred on the left side 3 months after a subcapital wedge osteotomy and a concavity of the femoral head appeared, which formed hinge abduction. Increase of the joint space and resolution of the hinge were achieved by arthrodiatasis. As arthrodiatasis can resolve hinge abduction by distraction and reduce mechanical stress, it may be taken into consideration as an option for diseases with hinge abduction.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
8/89. Laparoscopic diagnosis and treatment of an acute epiploic appendagitis with torsion and necrosis causing an acute abdomen.Acute epiploic appendagitis is not as rare as previously thought; but, since the presenting signs and symptoms are not specific, preoperative diagnosis has been rarely made. At the present time, a laparoscopic exploration of the peritoneal cavity will establish the correct diagnosis, and the treatment can be provided during the same procedure. Herein, a case of a 63-year-old female patient with acute abdominal syndrome caused by a necrotic epiploic appendix that was successfully diagnosed and treated laparoscopically is described. A review of the literature is made, as well.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
9/89. Brain injury after survived gunshot to the head: reactive alterations at sites remote from the missile track.Gunshot wounds to the brain usually lead to acute respiratory arrest or death after a brief survival period, even in cases involving only slight direct tissue damage. It can be assumed therefore that the damage extends beyond the zone of recognizable destruction and hemorrhages. To determine the true extent of the tissue injury resulting from gunshot wounds to the brain, we carried out microscopic investigations for reactive changes (emigration of leukocytes and macrophages, axonal expression of beta-amyloid precursor protein (beta-APP) in 10 cases of gunshot wound to the narrow channel of the brain with survival times >2h. Demonstration of leukocytes expressing naphthol AS-D chloroacetate esterase activity in the brain tissue at the border of the missile track established the vitality of the gunshot effect. The presence of macrophages (CD68-epitope) allowed demarcation of a 1-2mm wide necrotic zone around the permanent cavity. Within this zone and beyond, beta-APP showed an initial increase followed by a decline in the number of injured axons. Three types of beta-APP positive staining could be differentiated. In the immediate vicinity of the missile track beta-APP positive neurons were present at a distance of 2-4mm from the margin of the permanent cavity (type 1) as a result of primary injured neuronal tissue by the gunshot itself. At longer distances from the narrow channel and the permanent cavity single beta-APP positive axons or axon fragments and two additional types were found; type 2 shows a parallel, wave-like arrangement of the damaged fibers, which suggests that the injury was produced by mechanical acceleration of the brain tissue created by the energy the projectile expended within the brain; irregular aggregation of beta-APP positive axons or axon fragments within a local edema represents type 3, which may be attributed to secondary ischemia or edema.- - - - - - - - - - ranking = 3keywords = cavity (Clic here for more details about this article) |
10/89. Disseminated pseudomonas aeruginosa and necrotizing pneumonia with complete recovery.pseudomonas aeruginosa pneumonia and recovery with treatment are rare in healthy individuals. We report the case of a 59-year-old man with P aeruginosa skin infection and sepsis, later giving rise to necrotizing pneumonia by hematogenous spread. He responded to prolonged intensive care and 3 weeks of piperacillin-tazobactam and tobramycin therapy. There was no evidence of immunosuppression other than that caused by alcoholism in this unusual case. The resulting cavity healed completely by fibrosis in 1 year.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
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