Focal Manifestations Research Articles

Langerhans cell histiocytosis of bone.

Langerhans cell histiocytosis (LCH), previously called histiocytosis X, refers to a spectrum of disease characterized by idiopathic proliferation of histiocytes producing focal or systemic manifestations. Causes and pathogenesis remain unclear. However, recent studies suggest abnormal immune regulation as an important factor. The three classic syndromes may have considerable clinical overlap: eosinophilic granuloma, in which the disease is limited to bone in patients usually 5-15 years old; Hand-Schüller-Christian disease, characterized by multifocal bone lesions and extraskeletal involvement of the reticuloendothelial system (RES) usually seen in children 1-5 years old; and Letterer-Siwe disease, in which there is disseminated involvement of the RES with a fulminant clinical course in children less than 2 years old. Osseous involvement is typically in the flat bones, with lesions of the skull, pelvis, and ribs accounting for more than half of all lesions. About 30% of lesions are in long bones. Radiographic appearance of osseous LCH depends on site of involvement and phase of the disease. Early lesions appear aggressive with poorly defined margins and lamellated periosteal reaction. Late lesions appear well defined and may show sclerotic margins and expanded remodeled appearance.

Non-typhoid <italic>Salmonella</italic> in Renal Transplant Recipients: a Report of Twenty Cases and Review of the Literature

We report 20 cases of non-typhoid Salmonella infection that occurred over a period of 10 years in 592 renal transplant recipients followed by our unit, and present a review of 58 previously reported cases. Analysis of these data suggests that infection occurs when immunosuppression is high (early in the post-transplant period, or after anti-rejection therapy). A significant number of patients have bacteraemia and widespread focal manifestations are common. Despite prolonged antibiotic therapy, relapses occur commonly causing significant morbidity, occasional graft loss and even death.

Migratory lobar nephronia

Lobar nephronia or focal bacterial nephritis is a pre-abscess stage of localized cellulitis and has been shown to represent a focal imaging manifestation of what is frequently a diffuse renal process. To the best of our knowledge, although multi-focal bacterial nephritis has been described, a migratory pattern has not been observed. This report describes a previously healthy 32-year-old woman with pathologically proven lobar nephronia that exhibited a migratory pattern on serial computed tomography (CT) and a prolonged course on antibiotic therapy. Possible etiologies for this unusual course, along with the CT, sonographic and needle biopsy features of this disease are discussed.

Optikusneuropathie und Querschnittsmyelitis: Eine seltene Befundkonstellation zentralnervöser Manifestationen des systemischen Lupus erythematodes (SLE)*

Focal central nervous system manifestations of systemic lupus erythematosus such as optic neuritis or transverse myelitis are rare occurring in less than 1 % of patients. Only five previous case reports have shown an association of these 2 symptoms in SLE. We describe another patient with SLE with binocular optic neuritis and subsequently developing transverse myelitis as the first manifestations of SLE. The spastic paraparesis of the lower extremities was successfully treated with high-dose steroids and cyclophosphamide whereas optic atrophy of the right eye developed during the course of the disease.

Focal Manifestations in Systemic Diseases of Internal Medicine

全身性疾患にみられる局所所見の重要性はいうまでもない. それは早期診断の手がかりを与えるだけではなく, 時に多臓器障害を示唆し, さらに予後と密接に関係することがあるからである. 局所所見から早期診断に結びつく内科的全身性疾患は数多くあげられる. 目につき易い局所所見は, 皮膚・眼・耳・鼻・口腔・関節などの病変であるが, 膠原病を例にとると皮膚症状では, 紅斑・結節・腫瘤・脱毛・レイノー現象・青色皮斑・皮膚硬化などがあげられ, これらはいくつかの疾患に共通して認められる. ここでは膠原病にみられる局所所見を呈示し解説する. さらに, 膠原病の局所所見は他臓器障害の存在を示唆し, 生命予後と関連することがある. その背景には, 抗核抗体を中心とする免疫異常が存在する. この点に関して自験SLEにおける局所病変と全身病態の解析結果について述べる.

Ganglioneurom des zervikalen Sympathikus begleitet von einer Salmonelleninfektion

A 70-year-old patient who was seen for evaluation of a parapharyngeal abscess is reported. Since clinical recovery could not be achieved by incision and Salmonella typhi-murium was isolated from the wound-swabs, the existence of two different affections at the same time was apparent. The histological examination after surgical excision led to the diagnosis of a ganglioneuroma. When the patient returned after one year with the clinical aspect of recurrence of the tumour, this pattern could not be verified; Salmonella typhi-murium, however, was found again in the former wound and the stool, too. The etiology of focal manifestations in connection with gastroenteric salmonella-borne infections is discussed.

The suppurative abscess of an endometriosic ovarian cyst due to salmonella brandenburg

We are reporting the suppurative abscess of an endometriosic ovarian cyst due toSalmonella brandenburg in a 30-year-old woman. We have stressed the extra-intestinal localization, e. g. an endometriosic ovarian cyst, and other well-known focal manifestations of salmonellosis.

Scintigraphic Findings of Uncommon Focal Manifestations of Haemophilus Influenzae Septicemia

Haemophilus influenzae septicemia is usually associated with a clinical focus of infection. The investigators describe early scintigraphic findings in some uncommon manifestations of H. influenzae septicemia.

Actinomycosis of Pericardium

ACTINOMYCOSIS is a progressive granulomatous disease with focal or systemic manifestations characterized by a tendency to produce multiple draining sinuses. 1 It is an uncommon infection, involving the heart in less than 2% of reported cases. 2 Heart disease is usually secondary to extension of primary thoracic actinomycosis. When the heart is involved, 42% of the patients have cardiac symptoms, with congestive heart failure predominating. 3 We present a case of actinomycotic purulent pericarditis and congestive heart failure in which the patient required pericardiectomy for restoration of normal cardiac function. Report of a Case A 51-year-old white woman was admitted with shortness of breath of two days' duration. She gave a history of low-grade temperature for the past two weeks and cough, nausea, and vomiting for the past four days. She was never hospitalized before except for tonsillectomy in early childhood. The patient was acutely ill, with shortness of breath;

Clinical Features of Neonatal Osteomyelitis

The records of 17 infants (1 to 28 days of age) with osteomyelitis who were admitted over a seven-year period were reviewed. There was a predominance of females (ten of 17). Neither shortened gestational age nor low birth weight seemed to be a predisposing factor. Complications of pregnancy occurred in 41% (seven of 17) of the mothers and the deliveries were complicated in 47% (eight of 17). The majority (15 of 17) of the newborns had antecedent illnesses, or were subjected to potentially infective procedures in the perinatal period. Fifty-nine percent (ten of 17) had known exposure to illness in family members or other close contacts. In 14 of 17 infants the illness was not accompanied by systemic signs or symptoms with only focal manifestations of disease. The most frequent local findings were swelling, tenderness and decreased motion. Deep soft-tissue swelling was the most frequently noted early radiographic change. Penicillin-resistant Staphylococcus aureus (the predominant organism) was isolated in seven of 14 patients in which an organism was identified. Seven of the 17 neonates had multiple bone involvement. Joint involvement was present in 12 of 17 neonates and half of these had a significant functional deficit. Deformity was present in 10 patients four months to seven years after onset of disease; six of these had impaired function. There was one death due to aspiration pneumonia.

TRIGEMINAL NEURALGIA CAUSED BY CYSTICERCOSIS OF THE CAVUM MECKELII: REPORT OF TWO CASES.

The differential diagnosis between pr imary and secondary tr igeminal neuralgia often has considerable practical importance because of its therapeutic implications. However , in cases in which there is a known etiological agent, a secondary neuralgia may simulate clinically a pr imary form of this condition. Such event occurred in our ~ cases, and in itself consti tutes one of the reasons for this report. I n the cases under discussion, prosopalgias with the characteristics of a pr imary tr igeminal neuralgia were caused by cysticcrci located in the cavum meckclii. To our knowledge tile medical l i terature does not record any previous report on cysticercosis of the cavum meckelii. A bibliographical survey was done in the current indices, and several original articles on neurocysticercosis were reviewed, covering a total of 1,190 cases (clinical observations, clinicopathological or pathological reports only), and no references were found on paroxysmal tr igeminal neuralgia not associated with other focal neurological manifestations.

Neurocysticercosis: incidence, diagnosis and clinical forms

Neurocysticercosis: incidence, diagnosis and clinical forms

Intracranial venous thrombosis in early pregnancy

Intracranial venous thrombosis occurred in 2 patients in the first trimester of pregnancy. Cerebral veins were occluded in one, cerebellar veins in the other. In both instances there was progressive development of focal neurological manifestations associated with headache, stupor, and increased intracranial pressure. In the first instance, a craniotomy for decompression was lifesaving, and further permitted the gestation to proceed satisfactorily. In the second case, where the lesion was in the posterior fossa, a Torkildsen procedure was followed by prompt recovery of the patient.Diagnosis of this condition should be considered when rapidly developing focal signs occur during pregnancy, even in the earlier months.

SPONTANEOUS STROKES IN THE YOUNG

Article1 November 1958SPONTANEOUS STROKES IN THE YOUNGHAROLD STEVENS, Ph.D., M.D., F.A.C.P.HAROLD STEVENS, Ph.D., M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-49-5-1022 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe spontaneous occurrence of cerebrovascular accidents in normotensive healthy individuals is contrary to the conventional notion that arteriosclerotic and occlusive vascular disease of the brain is a phenomenon of old age. Yet strokes in the young are not rare. Thirty-two such cases in young adults and two in children have been encountered by the author in private neurologic practice in the last seven years.Acute hemiplegia and other focal neurologic manifestations characterize this group. The ages range from five and one-half years to 45 years, the arbitrary cut-off point of this selection. No cases are included that had traumatic, infectious,...Bibliography1. Stevens H: Cerebral venous thromboses in childhood, in press. Google Scholar2. Hyland H: Intracranial venous thromboses in the puerperium, J. A. M. A. 142: 707, 1950. CrossrefMedlineGoogle Scholar3. Stevens H: Puerperal hemiplegia, Neurology 4: 723, 1954. CrossrefMedlineGoogle Scholar4. StevensAmmerman HH: Intracranial venous thrombosis in early pregnancy, Am. J. Obst. and Gynec., in press. Google Scholar5. Stevens H: Carotid artery thrombosis in childhood, Pediatrics, in press. Google Scholar6. Fisher M: Occlusion of the carotid arteries, Arch. Neurol. and Psychiat. 72: 187, 1954. CrossrefGoogle Scholar7. KaplanWalker AA: Complications of cerebral angiography, Neurology 4: 643, 1954. CrossrefMedlineGoogle Scholar8. RowbothamHayKirby GRA: Technique and dangers of cerebral angiography, J. Neurosurg. 10: 602, 1953. CrossrefMedlineGoogle Scholar9. 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J. 65: 1, 1951. MedlineGoogle Scholar17. ClarkeHarrison EC: Bilateral carotid artery obstruction, Neurology 6: 705, 1956. CrossrefMedlineGoogle Scholar18. Bailliart P: Circulation artérielle rétinnienne, Ann. d'ocul. 154: 257, 1917. Google Scholar19. Magitot A: How to know the blood pressure in the vessels of the retina, Am. J. Ophth. 5: 777, 1922. CrossrefGoogle Scholar20. Van AllenBlodiBrintnall MFE: Retinal artery blood pressure measurements in diagnosis and surgery of spontaneous carotid occlusions, J. Neurosurg. 15: 19, 1958. CrossrefMedlineGoogle Scholar21. McDevittCarterGatjeFoleyWright ESBWI: Use of anticoagulants in treatment of cerebral vascular disease, J. A. M. A. 166: 592, 1958. CrossrefMedlineGoogle Scholar22. MillikanSiekertWhisnant CRJ: Anticoagulant therapy in cerebral vascular disease—current status, J. A. M. A. 166: 587, 1958. CrossrefMedlineGoogle Scholar23. RobWheeler CE: Thrombosis of internal carotid artery treated by arterial surgery, Brit. M. J. 2: 264, 1957. CrossrefMedlineGoogle Scholar24. GassSmathers HH: Carotid artery insufficiency corrected by internal carotid thrombectomy, Neurology 7: 670, 1957. CrossrefMedlineGoogle Scholar25. JacksonFromm IS: Observations on patency of cervical carotid artery following surgical treatment for thrombosis, J. Neurosurg. 14: 529, 1957. CrossrefMedlineGoogle Scholar26. BlumenthalHandlerBlache HFJ: The histogenesis of arteriosclerosis of the larger cerebral arteries, with an analysis of the importance of mechanical factors, Am. J. Med. 17: 337, 1954. CrossrefMedlineGoogle Scholar27. SeidenbergEcker RA: Psychodynamic and arteriographic studies of acute cerebral vascular disorders, Psychosom. Med. 16: 374, 1954. CrossrefMedlineGoogle Scholar28. Ecker A: Emotional stress before strokes: a preliminary report of 20 cases, Ann. Int. Med. 40: 49, 1954. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Washington, D. C.*Presented at the Thirty-ninth Annual Session of The American College of Physicians, Atlantic City, New Jersey, April 28, 1958.From the Department of Neurology, George Washington University School of Medicine, Washington, D. C.Requests for reprints should be addressed to Harold Stevens, M.D., Professor of Neurology, George Washington University School of Medicine, Washington, D. C. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPredictors of outcome of stroke in infants and children based on clinical data and radiologic correlatesIschemic cerebrovascular disease in the young. Two common causes in India.CEREBRAL VASCULAR DISEASE IN PREGNANCY 2-OCCLUSIONTHE LITTLE STROKEIntracranial venous thrombosis in early pregnancyInfluence of Some Vasoactive Drugs on Fibrinolytic ActivityTreatment of a Stroke 1 November 1958Volume 49, Issue 5Page: 1022-1034KeywordsAnticoagulantsLesionsNeurologyPathogensStrokeSyphilisThrombosisVascular diseasesVascular medicineYoung adults ePublished: 1 December 2008 Issue Published: 1 November 1958 PDF downloadLoading ...

Cerebral vascular insufficiency; an explanation of the transient stroke.

Acute cerebral vascular insufficiency may be defined physiologically as a deficiency of cerebral arterial blood flow resulting from an inadequate systemic arterial blood pressure or impairment of the cardiac output.1This condition is often transient and correctible, although the resulting deleterious effect upon the brain may or may not be permanent. The deficit in cerebral blood flow may involve the whole brain, or it may be localized. When it is generalized, the well-known symptoms of syncope, generalized grand mal seizures, etc. may occur. It has not been clearly recognized, however, that focal cerebral manifestations, such as hemiplegia, hemisensory disturbances, and Jacksonian seizures, are not uncommonly the result of localized cerebral vascular insufficiency. In the past, such disorders when permanent have been attributed to cerebral hemorrhage, thrombosis, or embolism. When focal cerebral signs have been transient, they have usually been considered a result of localized cerebral vascular spasm. It is

NEUROGENIC FACTORS IN THE PRODUCTION OF ACUTE GASTRIC ULCER

Study of fifteen cases of acute gastric ulceration associated with primary intracerebral disease shows no essential pathologic difference between these lesions and the acute gastric ulcer found in the absence of such disease. That the mucosal lesion is the result of an acute phase of gastric circulatory deficiency of a prolonged type is suggested by the presence of chronic degenerative changes in the deeper layers of the stomach wall. Moreover, similar degenerative changes dependent on chronic stasis in the circulatory beds found in other viscera in these cases demonstrate that the so-called neurogenic ulcer is not a primary, isolated phenomenon but a focal manifestation of subclinical generalized circulatory insufficiency. The absence of organic cardiovascular disease in this series, with a mean age of 34 years, permits the assumption that the generalized peripheral circulatory disturbances noted in the viscera mentioned are primarily related to an intracerebral condition. The nature of the

AN UNUSUAL MANIFESTATION OF SYPHILIS FOLLOWING TRAUMA

It has long been recognized that trauma may determine focal manifestations both in active and in latent syphilis. Stokes in his recent book mentions this, quotes numerous authorities and cites several cases of his own. 1 If syphilis may be likened to a fire-brand, lighting up latent disease in any part of the body, then trauma may be compared to a percussion cap that can set off without warning in a syphilitic patient an explosion of the disease which may be local or systemic in its manifestations. Just what happens at the site of the trauma is an interesting question which will not be discussed here. Does the Spirochaeta pallida take active control? Are the tissues, weakened by the syphilitic toxins, made more vulnerable? Are these factors combined in a varying degree in each case, according to the resistance of the patient? Whatever the answers may be, the fact remains

THE PARALYTIC COMPLICATIONS OF HERPES ZOSTER OF THE CEPHALIC EXTREMITY

Idiopathic or true herpes zoster is an acute infectious disease characterized by general symptoms; fever, headache and great prostration and a focal manifestation; an eruption of herpes zoster on the skin and mucous membranes. The characteristic pathologic changes are found in the posterior spinal ganglia and in the Gasserian ganglion<i>(posterior poliomyelitis)</i>. These structures are derivatives of the so-called neural ridge, and the ganglion cells having this origin belong to the so-called unipolar or spinal type. The geniculate ganglion, the ganglia of the glossopharyngeal and vagus nerves, as well as the auditory ganglia (the<i>ganglion</i>of<i>Scarpa</i>and the<i>ganglion spirale</i>) also take their origin from the neural ridge, and as such must be brought within the realm of the specific ganglionic inflammation of herpes zoster. The affected ganglion is the seat of an hemorrhagic inflammation which gives rise to pains (herpetic neuralgia), objective sensory disturbances and an eruption of