Parapharyngeal metastasis in hepatocellular carcinoma-a rare entity.

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver. It most commonly metastasizes haematogenously to the lungs and bones, less commonly via lymphatics to lymph nodes. However, metastasis to the parapharyngeal space has yet to be reported. This is the first clinical report of the treatment of parapharyngeal metastasis from HCC. The case of a 46-year-old man who was found to have a parapharyngeal soft tissue mass during routine follow-up 12 years post deceased-donor liver transplantation for hepatitis B-related HCC is reported here. This was investigated and diagnosed to be metastatic HCC. He underwent excision of the parapharyngeal metastasis, followed by adjuvant radiotherapy. Parapharyngeal metastasis is a rare occurrence in HCC. It is important to be cognizant of the possibility of disease spread to this location in order to ensure early detection and treatment. Surgical excision with adjuvant radiotherapy should be considered to achieve disease control.

Discovery of coarctation of the aorta following renal doppler sonography.

Coarctation of the aorta (CoA) is present in 0.4% of live births and in 7% of patients with congenital heart disease. While there may be florid presentations of congestive heart failure in the neonatal period, the diagnosis during adulthood is often delayed. We encountered a 20-year-old woman who was discovered to be hypertensive on routine check-up. Following bilateral abnormal renal doppler sonography, MR angiogram revealed a short-segment stenosis of the descending thoracic aorta. Review of her chest radiograph showed a small aortic knuckle. This case highlights an unconventional algorithm in diagnosing aortic coarctation in adulthood.

Imaging appearances of hepatic tuberculosis: experience with 12 patients.

AIM: To review computed tomography (CT), ultrasound (US), magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiogram (PTC) appearances and their diagnostic value in hepatic tuberculosis. MATERIALS AND METHODS: The imaging studies for 12 patients with biopsy-proven hepatic tuberculosis from January 2012 till March 2014 were reviewed retrospectively. These cases were confirmed via ultrasound-guided biopsy. RESULTS: The patients were aged 24-72 years. Four patients had parenchymal tuberculosis only and eight patients had mixed parenchymal and biliary duct involvement. The parenchymal tuberculosis patients showed poorly enhancing, hypodense nodules on CT with central calcification and adjacent dilated intrahepatic ducts. Most patients had multiple lesions except for two patients with a single lesion. The size of the lesions ranged from 0.5 to 6 cm. Seven patients with biliary duct involvement showed a hilar strictures involving the intrahepatic ducts and common bile duct. Nine of the patients showed hilar stricture with atrophy of the ipsilateral lobe of the liver and compensatory hypertrophy of the contralateral lobe. Hepatolithiasis was seen in five patients. Tuberculous lung involvement was seen in seven patients. CONCLUSION: The presence of calcified and hypodense nodules with biliary duct dilatation associated with lobar atrophy were the most consistent features of hepatic tuberculosis, especially in the presence of active lung disease.

Comparison of phenotypic methods and matrix-assisted laser desorption ionisation time-of-flight mass spectrometry for the identification of aero-tolerant Actinomyces spp. isolated from soft-tissue infections.

Aero-tolerant Actinomyces spp. are an under-recognised cause of cutaneous infections, in part because identification using conventional phenotypic methods is difficult and may be inaccurate. Matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) is a promising new technique for bacterial identification, but with limited data on the identification of aero-tolerant Actinomyces spp. This study evaluated the accuracy of a phenotypic biochemical kit, MALDI-TOF MS and genotypic identification methods for the identification of this problematic group of organisms. Thirty aero-tolerant Actinomyces spp. were isolated from soft-tissue infections over a 2-year period. Species identification was performed by 16 s rRNA sequencing and genotypic results were compared with results obtained by API Coryne and MALDI-TOF MS. There was poor agreement between API Coryne and genotypic identification, with only 33% of isolates correctly identified to the species level. MALDI-TOF MS correctly identified 97% of isolates to the species level, with 33% of identifications achieved with high confidence scores. MALDI-TOF MS is a promising new tool for the identification of aero-tolerant Actinomyces spp., but improvement of the database is required in order to increase the confidence level of identification.

Bacterial contamination of hands and the environment in a microbiology laboratory.

This study investigated both the impact of glove usage on bacterial hand contamination of laboratory technicians and extent of environmental contamination of a microbiology laboratory with potential bacterial pathogens. Two groups of laboratory technologists participated in the study - one group who always used gloves when handling bacterial cultures and another group who did not. Semiquantitative bacterial sampling from technicians' hands was performed before and after a defined work period. Frequently touched areas of the laboratory were sampled over a four-week period and selective or chromogenic media utilised for the identification of meticillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Salmonella spp. and Enterobacteriaceae. Laboratory technicians who did not use gloves were at significantly greater risk of acquiring MRSA following their work periods but no protective effect was demonstrated for glove usage against acquisition of Enterobacteriaceae. Hand washing was equally effective at removing acquired bacterial pathogens in both groups of workers. Environmental sampling documented the presence of MRSA in one-fifth of sampled sites, with the most frequent recovery from computer keyboards. Enterobacteriaceae and P. aeruginosa were less commonly recovered from the environment. This study demonstrates that glove usage is protective against the acquisition of MRSA and that MRSA is the most frequently recovered bacterial pathogen from our microbiology laboratory environment.

Screening options for Down syndrome: how women choose in real clinical setting.

OBJECTIVE: To study pregnant women's preference among various screening options for Down syndrome (DS) in routine clinical setting, and its potential association with women's demographic characteristics. METHODS: Women aged 35 years and older carrying singleton pregnancy were offered a variety of screening tests for DS before 14 weeks of gestation. Their preference was confirmed by the test they actually underwent. The association between women's choice of test and a number of demographic characteristics was studied using multinomial regression. RESULTS: Among 1967 eligible women, 619 opted for first-trimester screening test (FTS), 924 for partial integrated test (PIT), and 424 for full integrated test (FIT). Nulliparous women and working mothers were more likely to choose FTS and FIT. Women with history of subfertility were more likely to choose FIT. Women with family history of chromosomal abnormalities were more likely to choose FTS. The choice of screening test could be predicted for 49.9% of women using four demographic characteristics. CONCLUSIONS: Among older women of predominantly Chinese ethnicity, integrated test is a favorite alternative to FTS. Their choice of DS screening test can be predicted by their obstetric and socioeconomic characteristics. Many women show willingness to pay for a test with a lower false-positive rate.

Evaluation of disc susceptibility tests performed directly from positive blood cultures.

AIMS: To evaluate the accuracy of direct disc susceptibility testing performed from positive BACTEC blood culture vials, using a predetermined dilution protocol. METHODS: Direct susceptibility testing was performed from 432 positive blood culture vials, generating 3829 antibiotic-organism results. Results were compared with those obtained by standard disc susceptibility testing according to Clinical Laboratory Standards Institute (CLSI) methods. RESULTS: When results were compared with the reference method, no very major errors were detected. One (0.03%) major error and 89 (2.3%) minor errors were found. Error rates by organism group ranged from 1.3% for Pseudomonas aeruginosa to 8.2% for beta-haemolytic streptococci. CONCLUSIONS: Direct susceptibility testing provided accurate susceptibility results for most organism-antibiotic combinations, with the exception of the beta-haemolytic streptococci.

Possible influences of ginseng on the pharmacokinetics and pharmacodynamics of warfarin in rats.

We evaluated the significance of a reported clinical case of drug-drug interaction between ginseng and warfarin using a robust pharmacokinetic/pharmacodynamic approach in a rat model. The influence of ginseng on the pharmacokinetics and pharmacodynamics of oral warfarin after a single dose (2 mg kg(-1)) and at steady state (0.2 mg kg(-1) daily x 6 days) was studied in male Sprague-Dawley rats. Prothrombin time was employed as a pharmacodynamic index. Warfarin plasma concentration and vitamin K content in the ginseng extract were assessed by validated HPLC assays. The pharmacokinetics of warfarin after a single dose were not altered in the presence of ginseng; peak plasma concentration (control 7.8+/-0.5; ginseng 7.3+/-2.5 microg mL(-1)), time to peak (control 2.6+/-1.0; ginseng 3.1+/-1.1 h), elimination half-life (control 14.3+/-5.8; ginseng 10.6+/-3.1 h), and oral clearance (control 17.5+/-3.3; ginseng 20.2+/-5.5 mL h(-1)) were not significantly different (P>0.05). Similarly, alterations in the pharmacokinetics of warfarin were not detected under the multiple dosing paradigm. Under both dosing conditions, ginseng also showed no significant impact on the pharmacodynamics of warfarin as assessed by the area under the prothrombin time vs time curve (multiple dosing; control 3776+/-619, ginseng 3830+/-362 sh) and maximum prothrombin time (control 57.2+/-11.8, ginseng 63.3+/-9.1 s). Furthermore, the content of vitamin K was undetectable in the ginseng decoction. In conclusion, current data obtained in the rat showed no significant impact of ginseng on the pharmacokinetics/pharmacodynamics of warfarin when they are concomitantly administered.

Malignant large-cell non-Hodgkin's lymphoma of the spleen.

Primary malignant tumours of the spleen are rare, with non-Hodgkin's lymphoma being the most common. A case of malignant large-cell lymphoma of the spleen in a patient with unexplained splenomegaly, is presented. There are very few previous reports on this condition in the radiological literature. The sonographic, computed tomographic and angiographic findings are described, with a brief review of the literature on this condition. Although there are no specific radiological findings to diagnose this condition, it has to be considered in the differential diagnosis of a solitary lesion in the spleen.

Cavernous transformation of the portal vein--sonographic findings.

Cavernous transformation of the portal vein may be seen following portal vein thrombosis. Ultrasound is a useful non-invasive procedure for demonstrating many abnormalities of the portal vein and surrounding structures. Two cases of cavernous transformation of the portal vein, diagnosed by ultrasonography, are presented.

A scanning and transmission electron microscopic study of the membranes of chicken egg.

Questions regarding the structure of the inner and outer shell membranes of the chicken egg were addressed in this study by correlating observations from light microscopy and scanning and transmission electron microscopy. The egg membrane had a limiting membrane, which measured .9 to .15 microns in thickness and appeared to be a continuous and an impervious layer, but the shell membrane did not. Under the SEM, each membrane was seen to be made up of several fibre layers. In the tear preparations viewed under the SEM two layers were observed in the egg membranes and three to five layers in the shell membrane, with an apparent plane of cleavage between each layer. Each fibre was made up of a central core and an outer mantle layers. The central core was perforated by channels which measured .08 to 1.11 microns in diameter and ran longitudinally along the length of the fibre. Between the mantle layer and the fibre core was a gap or cleft measuring between .03 to .07 microns. The diameter of the fibres of the inner layer of the egg membrane ranged between .08 to .64 microns, whereas those of the outer layer of the same membrane ranged from .05 to 1.11 microns. Fibres in the shell membrane ranged from .11 to 4.14 microns diameter.