Post-rhinoplasty mucous cyst formation of the nasal dorsum.

PROBLEM: Formation of a mucous cyst of the nasal dorsum after rhinoplasty is a rare complication, and a limited number of cases has been reported. Located subcutaneously, mucous cysts are thought to arise from traumatically displaced mucosal remnants. This may well be the result of inadequate surgical technique, and preservation of the mucosal lining, whenever possible, is therefore advocated when performing a rhinoplasty procedure. METHODOLOGY: We report a well-documented case of a patient with a mucous cyst of the nasal dorsum, which developed 40 years after the initial surgery. RESULTS: The cyst was excised through an external rhinoplasty approach. A thin-walled cyst, firmly attached to the bony pyramid, was easily removed from the overlying skin. CONCLUSIONS: Histopathological confirmation of such cysts is emphasized, as well as consideration of the technical aspects of prior surgery, since this may provide insight into risk factors involved.

Isolation of Salmonella from environmental samples collected in the reptile department of Antwerp Zoo using different selective methods.

AIMS: To evaluate the environmental spread of Salmonella strains in the reptile department of Antwerp Zoo and to compare different isolation methods for Salmonella. METHODS AND RESULTS: One hundred environmental samples were collected in the service sections and public spaces of the reptile department. After pre-enrichment in buffered peptone water (BPW), selective enrichment was performed in Rappaport Vassiliadis Single Component Enrichment Broth (RVS), Selenite Cystine Broth (SEL) and Mueller Kauffman Tetrathionate Broth (MKTTn). Subculturing on Modified Semisolid Rappaport-Vassiliadis (MSRV) Medium, and the combined use of immunomagnetic separation (IMS) and RVS was evaluated. The isolation media used were Hektoen Enteric Agar (HE), Phenol Red Brilliant Green Agar (BG) and Xylose Lysine Decarboxylase Agar (XLD). Salmonella strains were found in 47 samples (47.0%). Most isolations were made on HE after combined IMS/RVS enrichment. Sixty-six Salmonella strains were serotyped, 29 belonged to Salmonella enterica ssp. enterica (I), 3 to ssp. salamae (II), 29 to ssp. arizonae or diarizonae (IIIa/b), 4 to ssp. houtenae (IV) and 1 strain showed autoagglutination. In addition, a 10-year survey (1995-2004) of Salmonella serovars isolated from reptiles at Antwerp Zoo is presented. CONCLUSIONS: A high prevalence of Salmonella strains was noted in the service sections of the reptile department. Only a few isolations were made in the public spaces. Selective enrichment in RVS was the most efficient. In combination with IMS, this method gave an even higher isolation rate than the International Standard method (ISO 6579:2002). SIGNIFICANCE AND IMPACT OF THE STUDY: This study confirms the importance of reptiles as spreaders of Salmonella in their surroundings. The possible infectious risks for zoo personnel and visitors are evaluated. Improved laboratory protocols for the isolation of Salmonella from the environment are suggested.

A survey for Mycobacterium avium subspecies paratuberculosis in the Royal Zoological Society of Antwerp.

Paratuberculosis is a chronic intestinal disease of ruminants caused by Mycobacterium avium subspecies paratuberculosis (Map). Very little is known about the status of paratuberculosis in European zoos. In this study, the presence of Map in the animal collection of the Royal Zoological Society of Antwerp (RZSA) was investigated. Faecal and post mortem samples from 48 ruminants were used to set up cultures. DNA from faeces, tissue and positive cultures were tested by IS900 polymerase chain reaction (PCR). Additionally, 448 serum samples were tested with an ELISA kit. All culture samples were negative whereas PCR gave three positives on biopsy samples and one positive on faecal samples. With the ELISA, 21 sera could be classified as positive. There is evidence that Map is present in the RZSA but no high level faecal shedders could be detected. Further investigations are required in other European Zoos in order to complete the picture of Map infections.

Isolation of Cryptococcus neoformans in Antwerp Zoo's nocturnal house.

Cryptococcosis was diagnosed postmortem in a striped grass mouse (Lemniscomys barbarus) housed in the nocturnal department of Antwerp Zoo. Eight of the remaining mice in the cage were captured. Cryptococcus neoformans was isolated from the lung of one animal. Two mice had an elevated serum cryptococcal antigen titre. On examination of the pooled faecal samples collected from 17 animal species housed in 23 cages of the nocturnal department, the pathogenic yeast was isolated from the faeces of the striped grass mice and a degu (Octodon degus). Numerous Cr. neoformans colonies were isolated from a tree-trunk, tree-stumps, and decaying wood collected from a hollow tree used to decorate the animals cage. Subsequent examination in four other cages of the nocturnal department revealed that all the sampled tree-trunks were colonized by Cr. neoformans. The fungus was isolated from the air sampled in the cage of the degu. Air samples collected in the public and service corridors remained negative. All the isolated strains were identified as Cr. neoformans var. neoformans serotype A.

Occurrence of Listeria spp. in captive antelope herds and their environment.

Two juvenile scimitar-horned oryx (Oryx dammah) at the Wild Animal Park Planckendael died from acute septicemia caused by Listeria monocytogenes serovar 4b. Subsequently, Listeria spp. were isolated from the feces, food, and environment of seven antelope species and examined using a two-stage enrichment procedure in Fraser Broth, followed by isolation on PALCAM agar. A total of 40/170 samples (23.5%) was positive for Listeria spp. No organisms were cultured in 83/170 samples (48.8%), and 47 samples (27.6%) were overgrown with Bacillus spp. Nonpathogenic Listeria spp. were isolated from 16/70 fecal samples, 22/40 soil samples, and 2/60 feed samples. Listeria monocytogenes serovar 1/2b was isolated from two soil samples collected in the enclosure of the scimitar-horned oryx.

Isolation of Basidiobolus ranarum from ectotherms in Antwerp zoo with special reference to characterization of the isolated strains.

Ten Basidiobolus ranarum (= Basidiobolus haptosporus) strains, isolated from faeces of 102 different lower vertebrates (ectotherms) exhibited in Antwerp Zoo, or from their environment were studied for their temperature requirements, haemolysis and other enzyme activities in vitro. All isolates grew well at 25 and 37 degrees C. Three strains that produced undulated zygospore walls were haemolytic and positive for hyaluronidase. All the isolates produced urease, N-acetyl-beta-glucosaminidase, trypsin, lipase, lecithinase, gelatinase, collagenase and elastase, but failed to produce amylase, keratinase and beta-glucosidase. Three isolates failed to produce phosphatase. Only one strain failed to produce DNase. Aesculin was not hydrolysed. Chitinase activity was inconclusive. The results of this study illustrate the importance of exotic animals kept in temperate regions as carriers of potentially pathogenic organisms. In addition to the morphological characteristics, the identification can be based on enzymatic profiles. Enzymatic activity detection may help to explain the pathogenic mechanism of the fungus.

A fatal case of craniofacial necrotizing fasciitis.

A case of fatal craniofacial necrotizing fasciitis is described in a 72-year-old diabetic woman and management is discussed. Progressive infection of the eyelids occurred with involvement of the right side of the face. Computed tomography revealed soft tissue swelling. Antibiotic treatment was started and debridement performed; histopathology showed acute inflammation and thrombosis of the epidermis and dermis. Despite treatment, scepticemia occurred, resulting in death less than 48 h after presentation. At this time extensive necrosis had developed in the superficial fascia with undermining and gangrene of surrounding tissues. Streptococcus and Staphylococcus were the pathogens involved. Poor prognosis in similar patients has been associated with extensive infection, involvement of the lower face and neck, delayed treatment, advanced age, diabetes and vascular disease.

Mycobacteriosis caused by Mycobacterium genavense in birds kept in a zoo: 11-year survey.

We report on a disease in 27 birds (1 bird belonging to the order Coraciiformes, 3 to Piciformes, 4 to Galliformes, 7 to Psittaciformes, and 12 to Passeriformes) caused by fastidious mycobacteria. All birds were caged at the Antwerp Zoo and died suddenly between 1983 and 1994. Seventeen birds had no previous signs of disease, and 10 birds showed emaciation. Gross necropsy findings were generally nonspecific, but all the birds were smear positive for acid-fast bacilli (AFB). Histopathologic evaluation performed on 14 birds revealed predominantly intracellular AFB. Extracellular AFB were more abundant in advanced lesions, especially in necrotic areas. In the intestine the mucosal area was generally heavily infiltrated, suggesting an intestinal origin of the infection. There was extensive invasion of the lungs in most birds. In 11 birds sparse growth was obtained after at least 6 months of incubation on Löwenstein-Jensen medium or on Ogawa medium supplemented with mycobactin. Subculture was unsuccessful in all instances. The 16S rRNA gene sequence of the cultured organisms or tissues from seven birds revealed the characteristic signature sequence for Mycobacterium genavense. Direct bird-to-bird transmission in the zoo was unlikely, and the pathogenicity of M. genavense in birds seems to be limited. The source of M. genavense in nature and the epidemiology of the disease in birds remain obscure. As suspected for human cases of M. genavense infection, an oral route of infection has been suggested, and contaminated local water distribution systems may have been the source of the infection. Our study confirms that infections caused by M. genavense should be suspected in birds (especially in Passeriformes and Psittaciformes orders) that die suddenly without previous symptoms and that have AFB in tissues that are difficult to grow on conventional media.

[Life-threatening angioedema as a side effect of angiotensin-converting-enzyme (ACE) inhibitors]. / Levensbedreigend angio-oedeem als bijwerking van angiotensine-'converting'-enzym (ACE)-remmers.

During the past years, angioedema occurring in association with angiotensin converting enzyme (ACE) inhibitors is seen more and more often. This is due to the increasing use of these drugs for hypertension and congestive heart failure. If the diagnosis is missed and prescription of the ACE inhibitor is prolonged, recurrent and more severe episodes of angioedema may occur. In case of involvement of the upper airway and respiratory distress, the condition may be life-threatening. We demonstrate three such patients, men of 84, 73 and 63 years old. First of all, the airway should be secured. Administration of epinephrine may be indicated. Further use of ACE inhibitors is contraindicated.

Expression of intermediate filament proteins in the adult human vestibular labyrinth.

The immunohistochemical detection of intermediate filament proteins, cytoskeletal constituents that allow the characterization of tissues, was investigated in frozen sections of the chemically fixed, nondecalcified, adult human vestibular labyrinth. Cytokeratins (CKs) were detected in all epithelia (including the sensory epithelia), although substantial differences in the degree of staining between individual cells occurred. The expression of CKs 7, 8, 18, and 19 as detected with our subunit-specific monoclonal antibodies in the vestibular epithelia is typical of "simple" epithelia and is identical to the CK subtypes found in the human cochlea. Although immunostaining for CK 7 was very weak and was limited to certain vestibular wall cells, the other CKs demonstrated a pronounced and rather uniform distribution throughout the different epithelia. All epithelia (including the sensory epithelia) displayed expression of vimentin, thus demonstrating co-expression with CKs. Vimentin was also present in the subepithelial connective tissue fibroblasts and mesothelial lining of the vestibular labyrinth. Neurofilament proteins were detected in all neuronal structures. The intense staining for CKs in the maculae and cristae implies that these sensory organs are rigid structures, a finding that may possibly be of importance in the mechanoelectrical transduction process for the sense of equilibrium.

CT and MR findings in ruptured dermoid cyst in the right parasellar cistern: report of a case.

A case of ruptured dermoid cyst in the right parasellar cistern imaged by MRI and CT is reported. The disseminated lipid droplets were found scattered throughout the subarachnoid spaces including the prepontine cisterns, in front of the right petrous apex as well as bilaterally in the frontal horns. The density of the lipid droplets was comprised between -80 and -100 HU. The lesions were hyperintense on T1-weighted images and hypointense on T2-weighted images.

Expression of intermediate filament proteins in the adult human cochlea.

The immunohistochemical localization of intermediate filament proteins was studied in frozen sections of chemically fixed, nondecalcified adult human cochleas. Cytokeratins were found in all epithelial cells lining the cochlear duct (including most supporting cells of the organ of Corti) but were absent in the hair cells. Neurofilament proteins were present in the nerve endings at the hair cells, in the neural bundles, and in the ganglion cells. Vimentin staining occurred in most of the supporting structures and was roughly complementary to the regions showing cytokeratin staining and neurofilament staining. However, the region of the spiral prominence and outer sulcus, as well as the pillar cells and Deiters' cells in the organ of Corti, showed coexpression of vimentin and cytokeratins. No definite immunostaining was observed with antibodies to desmin and glial fibrillary acidic protein.

Differential immunohistochemical detection of cytokeratins and vimentin in the surgically removed human endolymphatic duct and sac.

Immunohistochemical detection of intermediate filament proteins and different subgroups of cytokeratins (Cks) was used to characterize the epithelium of the surgically removed adult human endolymphatic duct (ED) and sac (ES). The epithelium of the ED and ES demonstrated immunostaining for Cks 7, 8, 14, 17, 18 and 19, a pattern typical of so-called "complex" or "mixed" epithelia. This is a remarkable finding, since this pattern differs strikingly from previously reported data on the adult human cochlea and vestibular labyrinth that demonstrated a Ck pattern typical of "simple" (or single-layered) epithelia. Furthermore, the epithelium of the ED and ES demonstrated co-expression of Cks and vimentin. The present data indicate that the epithelium of the ED and ES exhibits another type of epithelial differentiation and demonstrates a higher degree of complexity than the other epithelia in the adult human inner ear.

Cytokeratin expression in the epithelia of the adult human cochlea.

Epithelia can be characterized by the specific expression pattern of their cytokeratin components. Therefore, we investigated the immunohistochemical expression of different cytokeratin subunits in frozen sections of chemically fixed, non-decalcified, adult human cochleas. The organ of Corti and the marginal cells of the stria vascularis showed reactivity for cytokeratin subunits 8, 18 and 19, whereas the other cochlear epithelia in addition expressed cytokeratin 7. The expression of cytokeratins 7, 8, 18 and 19 by the epithelia of the adult human cochlea is typical of "simple" epithelia. The deviant cytokeratin pattern of the organ of Corti and marginal cells of the stria vascularis may well reflect their differences in functional state and/or differentiation as compared to the other cochlear epithelia.

Progress in temporal bone histopathology. III. An improved technique for immunohistochemical investigation of the adult human inner ear.

A new tissue processing technique is described for immunohistochemistry of the adult human inner ear, avoiding the immuno-compromising step of prolonged decalcification. The procedure allows reliable investigation of frozen sections of the chemically fixed, non-decalcified, adult human cochlea and vestibular sense organs. Preservation of immunoreactivity, combined with satisfying tissue morphology, is illustrated by the immunohistochemical localization of the intermediate filament constituents cytokeratins and neurofilament proteins throughout the membranous labyrinth.

[Diagnostic value of thallium 201 scintigraphy in the determination of malignancy of cold thyroid nodules]. / La valeur diagnostique de la scintigraphie au thallium 201 dans la détermination de la malignité du nodule froid thyroïdien.

In this paper we discuss and quantify the respective values of Thallium 201 scintigraphy and cytologic punction in determining malignancy of the cold thyroid nodule. These two diagnostic tests are evaluated on the basis of their sensitivity and specificity while taking into consideration various therapeutic attitudes in the presence of a cold thyroid nodule.