Complete genomic characterization of bovine papillomavirus type 1 and 2 strains infers ongoing cross-species transmission between cattle and horses.

Infection with bovine papillomavirus (BPV) types 1 and 2 results in the most common skin tumor of horses, termed equine sarcoid. The persistent and recurrent nature of this tumor stands in contrast to the regressive nature of BPV-1/- 2 induced cutaneous papillomas in cattle. The circulation of horse-specific BPV-1/- 2 variants within equine populations has been suggested as a possible explanation for the difference in clinical presentation of BPV-1/- 2 infection between horses and cattle. In order to investigate this hypothesis, we identified 98 complete BPV-1/- 2 genomes using a Nanopore sequencing approach. Separate BPV-1/- 2 alignments were used to infer Bayesian phylogenetic trees. Phylogeny-trait association concerning host species was investigated using Bayesian Tip-association Significance software (BaTS) Overall, 179 unique BPV-1 and 128 BPV-2 substitutions were found. The E2 coding region in the viral genome exhibited an exceptionally high rate of non-synonymous mutations (81 %, n = 13/16). Interestingly, extensive deletions in the L1/L2 region (up to 1.5 kb) were found exclusively in horse-derived samples. Nevertheless, the most frequently detected single nucleotide polymorphisms were shared between equine and bovine hosts, which is in agreement with BaTS results indicating no phylogeny-host correlation. We found indications that horse-specific mutations might exist in subpopulations of equine derived BPV-1/- 2, but these did not result in horse-adapted genetic variants. Based on these observations, cross-species transmission from cattle to horses seems to be an ongoing process, rather than an ancient occurrence that has been followed by the circulation of horse-adapted BPV variants in the horse population..

Can the hoof be shod without limiting the heel movement? A comparative study between barefoot, shoeing with conventional shoes and a split-toe shoe.

Conventional shoeing restricts heel movement, which may have a negative effect on the orthopaedic health of the horse. A randomised crossover experimental study using noninvasive techniques was performed to compare the mediolateral heel movement in barefoot horses, horses shod with a conventional toe clipped shoe and with a new type of shoe with a split toe. In eight horses, 16 forelimbs were tested barefoot, shod with a conventional shoe and with the split-toe (ST) shoe, in random order. A displacement sensor was secured on the heels and measurements were collected continuously at a frequency of 679Hz while horses were exercised on a treadmill at the walk (1.8m/s), trot (3.5m/s) and canter (8m/s). Differences in heel movement between the conditions were analysed using a generalised estimating equations approach. The conventional shoe was associated with significantly less heel expansion compared with the ST shoe and barefoot situation in all gaits (P≤0.001). Heel expansion with the ST shoe was not significantly different from the barefoot condition. For all gaits, shoeing was associated with a significant reduction in heel contraction compared with the barefoot situation (P≤0.038), except for the heel contraction at the canter using a conventional shoe. In conclusion, the heel expansion with the ST shoe did not differ significantly from when the horse was barefoot, in contrast with the significant restriction of the heel movement when a conventional shoe was used.

The clinical diagnosis of equine sarcoids-Part 2: Assessment of case features typical of equine sarcoids and validation of a diagnostic protocol to guide equine clinicians in the diagnosis of equine sarcoids.

Research has shown that the accuracy of the clinical diagnosis of equine sarcoids (ES) can be improved. Particularly, less experienced veterinarians are often mistaken in their clinical judgement despite a high level of diagnostic confidence. The aim of this study was to develop and assess the performance of a diagnostic protocol (DP) to improve diagnostic accuracy and identify diagnostically challenging cases. The design of the DP was based on typical clinical features of ES and its algorithm was optimised through repeated tests on clinical cases prior to validating its performance in a representative online examination. A total of 22 equine practitioners and 31 veterinary students used the DP to diagnose 40 standardised ES and non-ES cases in an online examination. Scores of these 53 respondents were compared to scores of 128 respondents of comparable levels of expertise, and 14 experts, all assessing the same cases without using the DP. Overall, respondents using the DP were significantly more likely (odds ratio (OR) 1.25; 95% confidence interval (95% CI) 1.09-1.43) to diagnose a case correctly compared to respondents not using the DP and felt significantly more confident of their diagnosis (OR 1.53; 95% CI 1.39-1.67). Thus, the DP proved to be a reliable tool to increase clinical diagnostic accuracy and diagnostic confidence. The DP algorithms may be further improved with experiences gained from its application in equine practice and clinicians will be able to optimise their diagnostic accuracy and selection of lesions requiring a biopsy.

The clinical diagnosis of equine sarcoids - Part 1: Assessment of sensitivity and specificity using a multicentre case-based online examination.

Equine clinicians and researchers often make the diagnosis of equine sarcoids (ES) on clinical assessment alone, without histopathological confirmation. However, the accuracy of the clinical diagnosis of ES has not been critically assessed. To assess sensitivity, specificity, positive and negative predictive values of the clinical diagnosis of ES, 40 clinical cases with histologically confirmed equine skin lesions (26 ES and 14 non-ES) were compiled in a representative online examination. For each case and lesion, at least one photograph and all relevant information were presented in a standardised format. This included the horse's signalment, lesion localisation, lesion progression, presence of other skin lesions, earlier treatments and response to treatment. No information relevant for the assessment of the lesion was intentionally withheld. Fourteen ES experts, 39 board-certified equine specialists, 103 equine practitioners and 25 novices categorised the cases into ES or non-ES and graded their level of diagnostic confidence on a scale from 1 to 6 for each case. The overall success rate was 82.0% while sensitivity and specificity were 83.3% and 79.6%, respectively. The positive and negative predictive values were 88.4% and 72.0%, respectively, in the tested population with a 66% prevalence of ES. However, less experienced veterinarians were frequently wrong in their clinical judgement despite a high level of diagnostic confidence. Therefore, the authors propose to develop a diagnostic tool to help clinicians optimise their selection of lesions requiring a biopsy. Ultimately, this will help reduce costs and morbidity generated by unnecessary diagnostic and therapeutic efforts.

Equine cheek teeth occlusal fissures: Prevalence, association with dental wear abnormalities and occlusal angles.

BACKGROUND: Fissures of the occlusal surface of equine cheek teeth are commonly encountered during oral examination but their aetiology is unknown. OBJECTIVES: To examine the prevalence and characteristics of occlusal fissures in cadaver teeth. It is hypothesised that their prevalence is influenced by masticatory forces. Consequently, their possible association with wear disorders and occlusal angles were examined. STUDY DESIGN: Cross-sectional survey. METHODS: The dental abnormalities and occlusal fissure findings in the cheek teeth of 143 cadaver heads were recorded. The cheek teeth occlusal angles were measured using the stiff-hinge technique. Multiple regression analyses were performed to establish possible relationships between age, sex, dental wear, occlusal angle and fissure prevalence. RESULTS: Occlusal fissures were found in 103/143 (72%) heads. Sex and age were determining factors in the prevalence of fissures. A similar prevalence was found in mandibular (54.1%) and maxillary teeth (45.9%, OR = 1.10; 95% CI = 0.95-1.29, P = 0.2). Mandibular fissures were more commonly located on the buccal aspect (OR = 1.42; 95% CI = 1.16-1.65, P < 0.001), whereas for maxillary fissures there was no difference in prevalence between palatal and buccal aspects (OR = 1.19; 95% CI = 0.97-1.46, P = 0.1). Two main fissure types were identified. Type 1a fissures were the most prevalent type (39.5%). No significant correlation was found between the presence of wear abnormalities or the occlusal angle of cheek teeth, and the prevalence of fissures. MAIN LIMITATIONS: No dental histories were available. CONCLUSION: Equine cheek teeth show a high prevalence of occlusal fissures. Despite some evidence of predilection sites on the tooth surface that might indicate a mechanical aetiology for these lesions, no associations were found with wear abnormalities or occlusal angles of affected cheek teeth. Further histological and ultrastructural studies are warranted to elucidate their aetiology and possible role in other dental diseases.

The possible role of Stomoxys calcitrans in equine sarcoid transmission.

The association between bovine papillomavirus (BPV) and equine sarcoids is well established, but it is unclear how the virus spreads. Although evidence in support of viral spread through direct animal contact exists, this does not explain sarcoid development in isolated equids. BPV DNA has been detected in flies, which could indicate that these insects serve as a vector. This study aimed to investigate whether BPV-negative stable flies (Stomoxys calcitrans) become positive for BPV DNA after exposure to equine sarcoid or bovine papilloma tissue under experimental conditions and, if so, for how long. A total of 420 stable flies were caught alive and exposed to BPV positive equine sarcoid or bovine papilloma tissue. During the following week, dead flies were collected daily and BPV loads were determined by quantitative PCR. There was a significant rise in BPV load after tissue exposure both in sarcoid and papilloma exposed flies, but the viral load was higher and remained high for a longer time after exposure to papilloma tissue compared to sarcoid tissue. Within days, viral loads decreased again and became indifferent from loads before exposure. The results of these experiments indicate that BPV transmission by S. calcitrans seems possible and is more likely to occur after contact with bovine papillomas than with equine sarcoids. Transmission seems only possible shortly after tissue exposure. Further research could include experimental induction of sarcoids with BPV positive stable flies, or a repeat of the experiment with micro-dissection prior to PCR.

A quantitative swab is a good non-invasive alternative to a quantitative biopsy for quantifying bacterial load in wounds healing by second intention in horses.

The aim of this study was to evaluate different techniques for diagnosing wound infection in wounds healing by second intention in horses and to assess the effect of a vortex and sonication protocol on quantitative bacteriology in specimens with a histologically confirmed biofilm. In 50 wounds healing by second intention, a clinical assessment, a quantitative swab, a semi-quantitative swab, and a swab for cytology were compared to a quantitative tissue biopsy (reference standard). Part of the biopsy specimen was examined histologically for evidence of a biofilm. There was a significant, high correlation (P<0.001; r=0.747) between the outcome of the quantitative swabs and the quantitative biopsies. The semi-quantitative swabs showed a significant, moderate correlation with the quantitative biopsies (P<0.001; ρ=0.524). Higher white blood cell counts for cytology were significantly associated with lower log10 colony-forming units (CFU) in the wounds (P=0.02). Wounds with black granulation tissue showed significantly higher log10 CFU (P=0.003). Specimens with biofilms did not yield higher bacteriological counts after a vortex and sonication protocol was performed to release bacteria from the biofilm. Based on these findings, a quantitative swab is an acceptable non-invasive alternative to a quantitative biopsy for quantifying bacterial load in equine wounds healing by second intention.

Topical distribution of acyclovir in normal equine skin and equine sarcoids: An in vitro study.

Topical acyclovir application is an owner-friendly treatment for occult equine sarcoids, without the caustic side-effects other topical treatments have. Variable clinical success rates have been described, but it is not known to what rate and extent acyclovir penetrates in and through equine skin from a topical formulation. In the current study, an in vitro Franz diffusion model was used to determine the permeation parameters for a generic 5% acyclovir cetomacrogol cream for both healthy and sarcoid equine skin. The distribution of acyclovir between different layers of both skin types was also evaluated. While acyclovir penetrated through both skin types, significantly less acyclovir permeated to the deep dermis of sarcoid skin (197.62ng/mm(3)) compared to normal skin (459.41ng/mm(3)). Within sarcoid skin samples, significantly higher acyclovir concentrations were found in the epidermis (983.59ng/mm(3)) compared to the superficial dermis (450.02ng/mm(3)) and the deep dermis. At each sample point, significantly more acyclovir permeated to the receptor fluid through normal skin compared to sarcoid skin, which is reflected in the significantly higher permeation parameters of normal skin. Normal skin was found to be more permissive for acyclovir, but even in sarcoid skin, enough acyclovir reached the deep dermis to treat a Herpes simplex virus infection. In the case of equine sarcoids, the treatment is aimed at the Bovine papillomavirus and no information is available on the susceptibility of the DNA polymerase of this virus for acyclovir. Therefore, further research is needed to determine the efficacy of acyclovir to treat equine sarcoids.

Diffusion of mepivacaine to adjacent synovial structures after intrasynovial analgesia of the digital flexor tendon sheath.

REASONS FOR PERFORMING STUDY: Controversy exists about the specificity of diagnostic analgesia of the digital flexor tendon sheath (DFTS) in horses. OBJECTIVES: To evaluate the degree of diffusion of mepivacaine from the equine DFTS to adjacent synovial structures. STUDY DESIGN: Crossover experiment. METHODS: Under general anaesthesia, the DFTS of one front and one hindlimb of 8 horses were injected simultaneously with mepivacaine. Synovial fluid samples of the injected DFTS, the adjacent metacarpo-/metatarsophalangeal (MCP/MTP) joint, proximal interphalangeal joint, distal interphalangeal joint, navicular bursa and contralateral MCP/MTP joint were collected 15 min post injection (T15) from one of the injected limbs and 60 min post injection (T60) from the other limb. Venous blood samples were obtained at T0, T15 and T60 to evaluate systemic distribution of mepivacaine. After a 2-week washout period, the procedure was repeated using the same limbs but reversing the time of sampling (front vs. hindlimbs). The concentration of mepivacaine in samples was measured with a commercial ELISA kit. RESULTS: Mepivacaine concentrations in the DFTS samples, at both T15 (5077 mg/l) and T60 (3503 mg/l), exceeded those estimated sufficient to produce synovial analgesia (100 mg/l or 300 mg/l). Mepivacaine was found in all synovial structures adjacent to the injected DFTS and in the contralateral MCP/MTP joints, but concentrations were low, with a maximum value of only 3.2 mg/l. With the exception of the navicular bursa samples, the mepivacaine concentrations in the adjacent synovial structures were significantly higher at T60 than at T15 (P<0.03). Significantly higher mepivacaine concentrations were found in the ipsilateral than the contralateral MCP/MTP joints at T60 (P<0.001). Blood samples had significantly higher mepivacaine concentrations at T15 and T60 than at T0 (P<0.001). CONCLUSIONS: Mepivacaine injected into the DFTS of horses diffuses towards adjacent synovial structures without achieving clinically relevant concentrations.

Rosettes and other white shiny structures in polarized dermoscopy: histological correlate and optical explanation.

BACKGROUND: Rosettes are a specific form of a white shiny structure seen with polarized dermoscopy. The precise morphological correlate and optical explication are not known. OBJECTIVE: To estimate the frequency of rosettes in ex vivo dermoscopy and to find explication and morphologic correlate of this dermoscopic feature. METHODS: A series of 6108 consecutive skin biopsies were examined with ex vivo dermoscopy and when rosettes were present serial transverse sections with polarization were examined. RESULTS: In this series of 6108 consecutive skin biopsies, rosettes were found on ex vivo dermoscopy in 63 cases. When multiple we observed that they are always oriented at the same angle. Transverse sections with polarization of these lesions proved that smaller rosettes are mainly caused by polarizing horny material in adnexal openings, and larger rosettes by concentric perifollicular fibrosis. CONCLUSIONS: Rosettes are an optical effect of crossed polarization by concentric fibrosis or horny material and hence are not lesion-specific.

Comparison of a new laser beam wound camera and a digital photoplanimetry-based method for wound measurement in horses.

The aim of this study was to compare the accuracy, precision, inter- and intra-operator reliability of a new laser beam (LB) wound camera and a digital photoplanimetry-based (DPB) method for measuring the dimensions of equine wounds. Forty-one wounds were created on equine cadavers. The area, circumference, maximum depth and volume of each wound were measured four times with both techniques by two operators. A silicone cast was made of each wound and served as the reference standard to measure the wound dimensions. The DPB method had a higher accuracy and precision in determining the wound volume compared with the LB camera, which had a higher accuracy in determining the wound area and maximum depth and better precision in determining the area and circumference. The LB camera also had a significantly higher overall inter-operator reliability for measuring the wound area, circumference and volume. In contrast, the DPB method had poor intra-operator reliability for the wound circumference. The LB camera was more user-friendly than the DPB method. The LB wound camera is recommended as the better objective method to assess the dimensions of wounds in horses, despite its poorer performance for the measurement of wound volume. However, if the wound measurements are performed by one operator on cadavers or animals under general anaesthesia, the DPB method is a less expensive and valid alternative.

Cutaneous infection by Alternaria infectoria in a liver transplant recipient: a case report.

We report the case of a 65-year-old man who developed multiple crusty ulcerative skin lesions on both lower extremities six months after liver transplantation. The causative pathogen was identified as Alternaria Infectoria, an opportunistic fungal agent. The patient was successfully treated with fluconazole for 27 weeks, with complete regression of the lesions. Due to the lack of well-designed clinical studies it is difficult to determine the best treatment course regarding solid organ transplant recipients presenting with invasive fungal infections. And for now, the clinician must lean upon case-reports or retrospective analyses to compose the most suited therapy for his patient. Based upon literature, it seems that the combination of a broad spectrum azole and reducing the dose of immunosuppressive drugs is the cornerstone of treating invasive fungal infections in solid organ transplant patients.

Peritumoral indoleamine 2,3-dioxygenase expression in melanoma: an early marker of resistance to immune control?

BACKGROUND: Indoleamine 2,3-dioxygenase (IDO) is an emerging immunomodulating factor in cancer. IDO expression in tumour-negative sentinel lymph nodes (SLNs) of patients with melanoma has a negative prognostic value. OBJECTIVES: To analyse the expression pattern of IDO and associated immunological changes in corresponding primary melanomas (PMs), SLNs and metastases. METHODS: In 120 patients with melanoma, PMs with corresponding SLNs (n = 85) and metastases (n = 18) were analysed by immunohistochemical staining for IDO and FoxP3. Tumour-infiltrating lymphocytes (TILs) were scored. IDO expression in stimulated peripheral blood mononuclear cells (PBMCs) was analysed in 27 patients. RESULTS: IDO expression in the sentinel node strongly correlated with endothelial IDO expression in the peritumoral stroma of the corresponding primary (P < 0·001) and metastatic melanoma (P < 0·05). Sentinel IDO positivity was inversely correlated with CD8+ lymphocytes (P = 0·01) and TILs (P = 0·05) in PM. Both IDO expression in the sentinel (P < 0·01) and the PM (P = 0·04) had a negative prognostic effect on overall survival, independent of Breslow thickness, sex, age, ulceration and sentinel invasion. IDO expression by PBMCs after stimulation with cytotoxic T-lymphocyte antigen 4 was not correlated with sentinel IDO expression but tended to correlate with disease stage (P = 0·04). CONCLUSIONS: Endothelial IDO expression is highly consistent in primary, sentinel and metastatic tissues of patients with melanoma, indicating that immune suppression in melanoma is determined very early in the disease course. This supports that IDO expression in melanoma is a marker of antitumour immune response with an independent prognostic value.

Aptitude-based assignment of nurses to depressed patients.

In psychiatric units, head nurses face the daily challenge of assigning nurses to patients. The 'match' between a patient and a nurse is not always optimal. This can hinder the therapeutic relationship. Aptitude is an important component of competence, especially for psychiatric nurses involved in therapeutic relationships. In this study, we undertook explorative research to investigate possible relationships between nurse aptitudes and outcomes in depressed patients. We found statistically significant relationships between specific nurse aptitudes, along professional rank, and particular patient outcomes. During the hospital stay, patients' depressive feelings change as they recover. Our results indicate that, as a patient's depressive feelings change, another type of nurse, one with an aptitude that supports the patient's current needs, should be assigned to care for that patient. This suggestion is at odds with current practises of assigning a patient to one nurse for the entire hospital stay.

Ideal versus corrected body weight for dosage of sugammadex in morbidly obese patients.

To date, the dosing of sugammadex is based on real body weight without taking fat content into account. We compared the reversal of profound rocuronium-induced neuromuscular blockade in morbidly obese patients using doses of sugammadex based on four different weight corrections. One hundred morbidly obese patients, scheduled for laparoscopic bariatric surgery under propofol-sufentanil anaesthesia, were randomly assigned four groups: ideal body weight; ideal body weight + 20%; ideal body weight + 40%; and real body weight. Patients received sugammadex 2 mg.kg(-1), when adductor pollicis monitoring showed two responses. The primary endpoint was full decurarisation. Secondary endpoints were the ability to get into bed independently on arrival to the post-anaesthetic care unit and clinical signs of residual paralysis. There was no residual paralysis in any patient. Morbidly obese patients can safely be decurarised from rocuronium-induced neuromuscular blockade T1-T2 with sugammadex dosed at 2 mg.kg(-1) ideal body weight + 40% (p < 0.0001).

Comparison of respiratory-triggered T2-weighted turbo spin-echo imaging versus breath-hold T2-weighted turbo spin-echo imaging: distinguishing benign from malignant liver lesions in patients with colorectal cancer.

T2-weighted turbo spin echo sequences are being used as a first sequence for abdominal magnetic resonance imaging in many cases. For oncological patients breath-hold imaging can be difficult. T2-weighted turbo spin echo sequences can be used during breath-hold or during respiratory-triggering. The purpose of our study is to compare a respiratory-triggered fat-suppressed and breath-hold T2-weighted Turbo Spin Echo (RT and BH FS T2w TSE) sequence for focal liver lesions. Prospectively, both T2w TSE sequences were acquired in 40 patients using 1.5T MRI. Qualitatively analysis was performed for image quality, lesion conspicuity, diagnostic confidence, artifacts using two-tailed Wilcoxon signed-ranks test. Quantitative analysis was performed for lesion-to-liver Contrast-to-Noise Ratio (CNR) using two-tailed Student's t-test. Qualitatively, RT FST2wTSE performed significantly (p < 0.05) better than BH FST2wTSE concerning image quality, lesion conspicuity, diagnostic confidence and artifacts. Seventy-eight metastases and 47 hemangiomas were detected on both FST2wTSE sequences. Seven liver metastases and 2 hemangiomas < 10 mm and 3 metastases between 10-20 mm detected on RT FS T2wTSE were only retrospectively detected on BH FS T2wTSE. Diagnostic confidence scores were best using RT FS T2w TSE compared with BH FS T2w TSE. Mean CNR of all lesions, mean CNR of all lesions < 10 mm and mean CNR between hemangiomas and metastases was significantly better using the RT sequence compared with the BH sequence. RT FST2wTSE might perform better than BH FST2wTSE for lesion detection and characterization in this study.

Aptitude of psychiatric nurses: conceptual considerations and measurement difficulties.

Patient allocation is common practice in psychiatric nursing. This study investigates nurse aptitude, a sub-concept of competence, to validate and refine patient allocation. The focus is on operationalizing aptitude for daily management purposes. Aptitude varies in function of the tasks to be performed and the therapeutic relationship of each psychiatric nurse with her individual patients. Time, job context, socio-cultural context and semantic frame of reference have also to be taken into account when operationalizing aptitude. Self and peer opinions are a basis for aptitude measurement as patient care and its management are shared among a small team of nurses. A meticulous idio-graphic analysis is necessary. These constraints generate several measurement difficulties that are to be dealt with without too many unrealistic assumptions. The research design enabled reliable aggregation of peer 'on' and 'from' opinions. These allowed confrontation of opinions and identification of bias in these. Stepwise explorative experimentation led to gauging and calibrating a specific aptitude questionnaire to the context of psychiatric nursing. The final version is now being applied in practice in 14 wards of 11 hospitals in Flanders.

Improved focal liver lesion detection: comparison of single-shot diffusion-weighted echoplanar and single-shot T2 weighted turbo spin echo techniques.

The purpose of this study was to compare diffusion-weighted respiratory-triggered single-shot spin echo echoplanar imaging (SS SE-EPI) sequence using four b-values (b = 0, b = 20, b = 300, b = 800 s mm(-2)) and single-shot T2 weighted turbo spin echo (T2W SS TSE) in patients with focal liver lesions, with special interest in small (<10 mm) lesions. Twenty-four patients underwent routine MRI. The five sequences were compared qualitatively for image quality, lesion conspicuity and artefacts. Quantitative analysis was performed for lesion identification and lesion-to-liver contrast-to-noise ratio (CNR). Subgroup analyses were performed for different types of lesions with different sizes. Sequences were compared by rank order statistic (RIDIT) and Kruskal-Wallis test. The best image quality (p<0.05) was achieved with T2W TSE and the best lesion conspicuity (p<0.05) with T2W TSE for biliary cysts and SE-EPI diffusion-weighted imaging (DWI) (b = 20 s mm(-2)) for haemangiomas and metastases. Image artefacts were lowest (p<0.05) with T2W TSE. T2W TSE was found to be the best protocol (p<0.05) for the identification of biliary cysts and SE-EPI DWI (b = 20 s mm(-2)) for haemangiomas and metastases. The lesion-to-liver CNRs were highest on T2W TSE for biliary cysts and on SE-EPI diffusion-weighted imaging (DWI) for haemangiomas and metastases (p<0.05). This study shows the potential of SS SE-EPI DWI (especially with a b-value of 20 s mm(-2)) as a promising technique for detecting small (<10 mm) focal liver lesions.

Jaw fixation as the key to diagnosis of fibrodysplasia ossificans progressiva.

Fibrodysplasia ossificans progressiva is a very rare and disabling hereditary disorder of connective tissue characterised by symmetric congenital anomalies of the great toes and thumbs and by progressive heterotopic ossification of tendons, ligaments, fasciae and striated muscles. In this case we report a 17-year-old boy who presented with a painful swelling of the right mandibula with trismus. Multiple heterotopic soft tissue calcifications, severe scoliosis and typical anomalies of toes and thumbs on the radiographs were pathognomonic for fibrodysplasia ossificans progressiva.

Fibrolamellar hepatocellular carcinoma in a 65-year-old woman: CT features.

A 65-year old woman with recurrent deep vein thrombosis underwent a CT scan of the upper abdomen for detection of underlying malignancy. A fibrolamellar hepatocellular carcinoma with extrahepatic subdiaphragmatic satellite lesion was found. This uncommon tumor has distinct clinical, pathological, radiological and prognostic features and therefore it is important to distinguish it from benign liver tumors, especially FNH, and from other malignant liver tumors such as conventional HCC. Though the tumor characteristically occurs in younger patients, our case proves that older patients can also be affected.