CT and MRI Features of Middle Ear Fibrous Hamartoma of Infancy: A Case Report.

Fibrous hamartoma of infancy in the middle ear is extremely rare. We report the case of a 26-month-old male patient who presented with a mass in the left middle ear. A temporal bone CT scan showed complete opacification of the left middle ear and mastoid air cells without ossicular erosion. On MRI, the mass revealed heterogeneous signal intensities indicative of fat and fibrous components. A definitive diagnosis was made postoperatively based on the histological results. Although rare, fibrous hamartoma of infancy should be considered as a differential diagnosis of a middle ear mass during childhood.

Effect of distal access catheter tip position on angiographic and clinical outcomes following thrombectomy using the combined stent-retriever and aspiration approach.

PURPOSE: Mechanical thrombectomy using the stent-retriever in conjunction with the distal access catheter may improve the rates of successful revascularization and clinical outcomes in patients with acute stroke. We aimed to compare two different thrombectomy techniques, according to the position of the distal access catheter tip in the combined stent-retriever and aspiration approach. METHODS: In this retrospective study, patients with middle cerebral artery occlusion treated with the combined technique were divided into two groups based on the tip position of the distal access catheter: distal group (catheter placed adjacent to the thrombus) and proximal group (catheter placed in the cavernous segment of the internal carotid artery below the ophthalmic artery). Baseline characteristics, angiographic results, and clinical outcomes were compared. RESULTS: Eighty-three patients (distal group, n = 45; proximal group, n = 38) were included. Higher complete reperfusion was observed in the distal group (unweighted analysis: 66.7% vs. 42.1%, p = 0.025; weighted analysis: 74.0% vs. 28.8%; p = 0.002). In the multivariate analysis, the distal tip position was independently associated with complete reperfusion (unweighted analysis: aOR, 4.10; 95% CI, 1.40-11.98; p = 0.01; weighted analysis: aOR, 5.20; 95% CI, 1.72-15.78; p = 0.004). The distal group also showed more favorable clinical outcomes and early neurological improvement (unweighted analysis: 62.2% vs. 55.3%; p = 0.521, 60% vs. 50%; p = 0.361, respectively; weighted analysis: 62.7% vs. 61.1%; p = 0.877, 66% vs. 45.7%; p = 0.062, respectively). However, more arterial dissections were observed in the distal group (8.9%, n = 4 vs. 2.6%, n = 1; p = 0.36). In the distal group, one patient with vascular injury died due to complications. No cases of emboli in new territory were observed. CONCLUSIONS: Distal tip position of the distal access catheter has a significant impact on reperfusion in patients with acute ischemic stroke. However, there was also a higher rate of vascular injury as the catheter was advanced further. If advancement to the target lesion is too difficult, placing it in the cavernous internal carotid artery may be a viable method without complications.

A Case of Coronary Sinus Atresia with a Total Anomalous Cardiac Venous Drainage to the Left Atrium without Persistent Left Superior Vena Cava: Imaging Findings on Cardiac CT.

The coronary sinus (CS) is the venous drainage system of the heart. CS ostium atresia is a rarely seen cardiac malformation. Congenital atresia of the CS is usually found together with persistent left superior vena cava (LSVC) and other cardiac malformations. However, isolated congenital atresia of the CS is very rare. We present a rare case of isolated congenital atresia of the CS connecting the left atrium and coronary veins without persistent LSVC in a 58-year-old female.

Efficacy of Early Infliximab Treatment for Pediatric Crohn's Disease: A Three-year Follow-up.

PURPOSE: To investigate the efficacy of early infliximab use and to follow the progress of pediatric cases of Crohn's disease for 3 years. METHODS: We reviewed the medical records of 28 pediatric patients who had been treated with infliximab for Crohn's disease. Eighteen patients (the 'top-down' group) received infliximab and azathioprine for induction and maintenance therapy for the first year, and then were treated with azathioprine for 2 additional years. Ten patients who were refractory to conventional therapy were categorized in the 'step-up' group. All patients were followed for at least 36 months. Treatment efficacy was assessed by the relapse rate using the pediatric Crohn's disease activity index (PCDAI) score in each group at 12, 24, and 36 months. Blood samples were available from 10 patients, and were used to assess antibody to infliximab (ATI). RESULTS: The relapse rate in 'top-down' group was lower than that in 'step-up' group at 1, 2, and 3 years. But, just the relapse rate at the 2 years was significantly different. At 3 years, the relapse rate according to different characteristic variables (sex, age at diagnosis, involvement, PCDAI at diagnosis) was not significantly different. Only one patient treated with infliximab had an adverse event, consisting of dyspnea and tachycardia. ATI was not detected in the blood samples from 10 patients. CONCLUSION: Early induction with infliximab at diagnosis ('top-down' therapy) is effective for reducing the relapse rate compared to conventional therapies in pediatric Crohn's disease possibly for up to 3 years.

Bacillus pocheonensis sp. nov., a moderately halotolerant, aerobic bacterium isolated from soil of a ginseng field.

A Gram-positive, non-motile, endospore-forming bacterial strain, designated Gsoil 420T, was isolated from soil of a ginseng field in Pocheon Province, South Korea, and was characterized, using a polyphasic approach, in order to determine its taxonomic position. The novel isolate consisted of strictly aerobic, rod-shaped cells and was able to grow in medium supplemented with up to 12% NaCl at 25 degrees C and pH 6.5-7.0. Comparative 16S rRNA gene sequence analysis showed that strain Gsoil 420T fell within the radiation of the cluster comprising Bacillus species and formed a coherent cluster with Bacillus niacini (16S rRNA gene sequence similarity, 98.6%), Bacillus bataviensis (98.6%), Bacillus soli (98.3%), Bacillus drentensis (98.0%), Bacillus novalis (98.0%), Bacillus vireti (97.9%), Bacillus foraminis (97.6%), Bacillus fumarioli (97.4%) and Bacillus jeotgali (97.0%). The levels of 16S rRNA gene sequence similarity with respect to other Bacillus species with validly published names were less than 96.8%. Strain Gsoil 420T had a genomic DNA G+C content of 44.9 mol% and the predominant respiratory quinone was MK-7. The major fatty acids were anteiso-C15:0 (33.9%), iso-C15:0 (24.5%) and iso-C14:0 (19.9%). These chemotaxonomic results supported the affiliation of strain Gsoil 420T to the genus Bacillus. However, low DNA-DNA relatedness values and distinguishing phenotypic characteristics allowed genotypic and phenotypic differentiation of strain Gsoil 420T from recognized Bacillus species. On the basis of its phenotypic properties and phylogenetic distinctiveness, strain Gsoil 420T represents a novel species of the genus Bacillus, for which the name Bacillus pocheonensis sp. nov. is proposed. The type strain is Gsoil 420T (=KCTC 13943T=DSM 18135T).