1/94. Revival of tetracyclines--in the treatment of visceral leishmaniasis?A 37-year-old immigrant from kosovo who had been in switzerland for 2 years developed fever, cough, weight loss and malaise. serology (complement binding reaction) was positive for leptospirosis. The symptoms resolved very rapidly under vibramycin 2 x 100 mg/day for 3 weeks. However, a flare-up occurred after cessation of medication. Reexposure to tetracyclines improved the symptoms though they did not subside completely. bone marrow analysis demonstrated intracellular leishmania (amastigotes). Analysis of frozen serum preserved since the first hospitalisation and samples from the second admission were positive for leishmania (indirect fluorescence antibody test) and confirmed the diagnosis of visceral leishmaniasis. Reevaluation of the serology for leptospirosis was negative using the specific microagglutination method. Treatment with antimony for 28 days resolved all symptoms. The parasites of visceral leishmaniasis grow intracellularly and eradication may be impossible in patients with an impaired cellular immune response. Flare-ups thus recur in 60-100% of patients with organ transplants or AIDS, despite regular treatment. Our finding raises the question whether relapses are suppressed in immunocompromised patients by tetracyclines, drugs known to be well tolerated even under long-term exposure. Randomised studies are required in this setting.- - - - - - - - - - ranking = 1keywords = leishmaniasis (Clic here for more details about this article) |
2/94. Mesh plug migration into scrotum: a new complication of hernia repair.hernia repair is one of the most frequent operative procedures performed throughout the world. The technique has continued to evolve and we now are performing these repairs utilizing mesh as a patch and also as a plug. The mesh plug concept has been advocated by Rutkow and others. With this change in technique, we have seen a new complication of hernia repair - the migration of the mesh plug from the original hernia repair site into the scrotum. It presented as a large tender mass in the scrotum of a 45-year-old male who had had previous recurrent surgery. In addition, he again had a recurrent incarcerated hernia. Correction of the hernia and resection of the migrated mesh plug from the scrotum were carried out. It is recommended that both the patch and the plug be into position to avoid or reduce the risk of such a recurrence and plug migration.- - - - - - - - - - ranking = 9.8829898516933E-5keywords = world (Clic here for more details about this article) |
3/94. Relapse of cutaneous leishmaniasis in a patient with an infected subcutaneous rheumatoid nodule.Cutaneous leishmaniasis is a protozoal infection generally considered to be limited to the skin. In israel, the disease is common in geographically defined areas and is caused predominantly by leishmania major. Sporotrichoid subcutaneous spread has been reported but is uncommon. We describe a patient with rheumatoid arthritis, treated with methotrexate and prednisone, in whom numerous rheumatoid nodules concomitant with cutaneous leishmaniasis were found, mimicking sporotrichoid spread of the disease. In a rheumatoid nodule that was examined by electron microscopy, Leishmania parasites were found at intracellular and extracellular locations. This observation supports the hypothesis that cutaneous leishmaniasis parasites persist after clinical cure of the disease and may re-emerge as a result of immunosuppression.- - - - - - - - - - ranking = 1.1666666666667keywords = leishmaniasis (Clic here for more details about this article) |
4/94. Reactivation of cutaneous leishmaniasis after surgery.Cutaneous leishmaniasis (CL) is caused by a parasite from the genus Leishmania. infection is transmitted to humans from the bite of sandflies. We describe an 85-year-old man who developed CL on his face after recent cutaneous surgery in that site. The case is also unusual because the most likely source of exposure to the infection occurred over 50 years previously. polymerase chain reaction, slit-skin smear, serology and the leishmanin test were not helpful in diagnosis, which was confirmed by histopathological demonstration of the parasite.- - - - - - - - - - ranking = 0.83333333333333keywords = leishmaniasis (Clic here for more details about this article) |
5/94. Sporadic peutz-jeghers syndrome in a Nigerian.peutz-jeghers syndrome is a rare condition of muco-cutaneous pigmentation and polyposis of the gut. Reports of its occurrence from the Black world have been infrequent. A case is presented of an 18 year old Nigerian girl with pigmentation of the inner lips and soles of both feet, and recurrent attacks of abdominal pain necessitating two surgical procedures for intestinal obstruction with removal, in both cases, of polyps. Problems of complications and therapeutic modalities are discussed.- - - - - - - - - - ranking = 9.8829898516933E-5keywords = world (Clic here for more details about this article) |
6/94. Eosinophilic fasciitis preceding relapse of peripheral T-cell lymphoma.Although eosinophilic fasciitis (EF) may precede hematologic malignancy or Hodgkin's disease, association with peripheral T-cell lymphoma (PTCL) is extremely rare. Only four cases of EF preceding or concomitant PTCL have been reported in the world literature. We experienced the first Korean case of EF complicated by the later relapse of peripheral T-cell lymphoma. A 63-year-old Korean male has been followed at our outpatient clinic periodically after treatment for stage IV PTCL. He had been in complete remission for seven and a half years when he developed edema of both lower extremities followed by sclerodermatous skin change in both hands with peripheral eosinophilia. biopsy from the left hand showed fibrous thickening of the fascia with lymphoplasmacytic and eosinophilic infiltrate, consistent with EF. Twenty-five months later, a newly developed lymph node from the left neck showed recurrence of PTCL. EF may occur as a paraneoplastic syndrome associated with the relapse of PTCL. Therefore, in a patient with EF, the possibility of coexisting and/or future occurrence of hematologic neoplasm should be considered.- - - - - - - - - - ranking = 9.8829898516933E-5keywords = world (Clic here for more details about this article) |
7/94. paraganglioma of the external auditory canal: an unusual case.Primary paraganglioma of the external auditory canal is a rare otological finding. To date, only three cases have been reported in the world-wide literature. Such a tumour is now described in a 42-year-old female. The clinical and histopathological features of the case are discussed. The role of immunocytochemistry in defining diagnosis, from a large list of differentials, is illustrated. We present the first magnetic resonance images of this rare tumour and highlight the benefit of intra-operative frozen section in limiting surgery to canal excision.- - - - - - - - - - ranking = 9.8829898516933E-5keywords = world (Clic here for more details about this article) |
8/94. Factitious hypoglycemia: a tale from the arab world.The mother is usually the one who narrates the patient's history to the pediatrician. Listening and eliciting the parent's story is an art. One of the essential attributes of a good pediatrician is the readiness to believe the parent's story. mothers are good historians and careful observers. The axiom that the mother is always right is true in most instances. However, occasionally the clinician is deliberately misled by the storyteller, resulting in numerous and potentially dangerous diagnostic investigations. We describe a boy with recurrent hypoglycemic coma in whom the diagnosis of factitious hypoglycemia was delayed as it is believed to be nonexistent in our community. We emphasize that in all patients with recurrent hypoglycemia, estimation of c-peptide and insulin should be performed even when the clinical settings are not in favor of the diagnosis of munchausen syndrome by proxy.munchausen syndrome by proxy, hypoglycemia.- - - - - - - - - - ranking = 0.00039531959406773keywords = world (Clic here for more details about this article) |
9/94. Visceral leishmaniasis in human immunodeficiency virus (hiv)-infected and non-hiv-infected patients. A comparative study.Visceral leishmaniasis is an endemic infection in Mediterranean countries, where it has become a frequent complication of acquired immunodeficiency syndrome (AIDS). The incidence of visceral leishmaniasis is increasing in spain due to human immunodeficiency virus (hiv)-related cases, but some aspects of its epidemiology, clinical features, and management remain unknown. In addition, no comparative clinical studies about the disease in hiv-infected and non-hiv-infected patients have been reported. During a 24-year period, 120 cases of visceral leishmaniasis were diagnosed at our institution and 80 (66%) were associated with hiv infection. The mean age at diagnosis was higher in hiv-infected that in non-hiv-infected patients (33.2 versus 23.2 yr; p = 0.002), but the male/female ratio was similar in both groups. The main risk factor for hiv infection was intravenous drug abuse (78.7%). The clinical presentation of leishmaniasis was similar in both groups, but hiv-infected patients had a lower frequency of splenomegaly than hiv-negative individuals (80.8% versus 97.4%; p = 0.02). hiv-infected patients had a greater frequency and degree of leukopenia, lymphocytopenia, and thrombocytopenia. Most of them were profoundly immunosuppressed (mean CD4 lymphocyte count, 90 cells/mm3) at the time of diagnosis of leishmaniasis, and 53.7% had AIDS. The sensitivity of serologic studies for Leishmania was significantly lower in hiv-infected than in non-hiv-infected patients (50% versus 80%; p < 0.001), but the diagnostic yield of bone marrow aspirate (67.1% versus 79.4%) and bone marrow culture (62.9% versus 66.6%) was similar in both groups. After initial treatment, the response rate was significantly lower in hiv-infected than in non-hiv-infected individuals (54.8% versus 89.7%; p = 0.001). The relapse rate was 46.2% and 7.5%, respectively (p < 0.001). Secondary prophylaxis with antimonial compounds or amphotericin b seems to be useful in preventing relapses in hiv-infected patients. The mortality rate was higher (53.7% versus 7.5%; p < 0.001) and the median survival time shorter (25 versus > 160 mo; p < 0.001) in AIDS patients than in hiv-negative individuals. Although leishmaniasis could contribute to death in a significant number of hiv-infected patients, it was the main cause of death in only a few of them. The CD4 lymphocyte count and the use of highly active antiretroviral therapy and secondary prophylaxis for leishmaniasis were the most significant prognostic factors for survival in AIDS patients. Visceral leishmaniasis behaves as an opportunistic infection in hiv-infected individuals and should be considered as an AIDS-defining disease.- - - - - - - - - - ranking = 2keywords = leishmaniasis (Clic here for more details about this article) |
10/94. Visceral leishmaniasis in an AIDS patient on successful antiretroviral therapy: failure of parasite eradication despite increase in CD4 T-cell count but low CD8 T-cell count.An unusual cutaneous relapse of visceral leishmaniasis (initially mistaken for eruptive histiocytomas) was seen in an AIDS patient despite good virological and CD4 T-cell responses to highly active antiretroviral therapy. splenectomy and the patient's low CD8 T-cell count are discussed as possible causes of failed disease control.- - - - - - - - - - ranking = 0.83333333333333keywords = leishmaniasis (Clic here for more details about this article) |
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