Cerebral vasculitis and Cardiobacterium valvarum endocarditis.

We present a case of aortic and tricuspid native valve endocarditis in which Cardiobacterium valvarum was isolated from the blood culture of a 65-year-old man. Cardiobacterium valvarum is a fastidious, Gram-negative bacillus. The genus Cardiobacterium encompasses two species - Cardiobacterium valvarum and Cardiobacterium hominis. Although both species rarely feature as the aetiological agent of endocarditis, Cardiobacterium hominis has a higher incidence than Cardiobacterium valvarum. For this causative organism, we believe this is the first report of fatality prior to surgical intervention and the first clinical course to be complicated by cerebral vasculitis. Native valve endocarditis caused by Gram-negative bacilli is extremely rare and identification of isolates may require the use of reference laboratories with molecular identification techniques.

Left superior vena cava: revisited.

The persistence of a left-sided superior vena cava is the most common variant of systemic venous drainage. Increased utility of cardiac imaging, in particular cross-sectional techniques such as computed tomography and magnetic resonance (MR), will result in increased detection of the anomaly and its variants. Whilst in the typical form it is often haemodynamically insignificant, its discovery may have clinical significance nonetheless, and its mimics require exclusion. During cardiac development the anomaly results from a failure of the left anterior cardinal vein to obliterate. Recognized anatomical variants include the absence of the right superior vena cava and of an innominate bridging vein. Typical drainage is to the coronary sinus, dilatation of which may be the first hint to the anomaly. Clinical implications with respect to vascular access and arrhythmia are well described. A significant minority drain into the left atrium, potentially creating a haemodynamically significant lesion. Additionally, differentiation from anomalous left upper pulmonary venous drainage via a vertical vein is mandatory. A newly discovered variant runs an intra-atrial course with subsequent typical drainage, and if not recognized as such, may be confused with a left atrial mass. The use of 3D contrast-enhanced MR venography has proven extremely helpful in characterizing anomalous vasculature, and we demonstrate how such techniques can help delineate the anomaly and differentiate from its mimics.

Using a <670> zone axis for convergent beam electron diffraction measurements of lattice strain in strained silicon.

Convergent beam electron diffraction patterns of silicon from the gate channel region of a complementary metal-oxide-semiconductor transistor with recessed Si(.82)Ge(.18) stressors were analysed using three zone axes: <230>, <340> and <670>. Values measured using these axes were compared with each other with regards to strain along the [110] and the [001] directions. It was demonstrated that strain measurements made using all three axes showed reasonable agreement with each other: an increase in the [110] compressive strain and a switch from compressive to tensile strain in the [001] with decreasing distance below the gate. It was also observed that the strain calculations using the <230> axis had the lowest uncertainty whereas the <670> axis allowed for measurements closest to the gate due to the improved lateral resolution at that tilt angle.

The correlation between ion beam/material interactions and practical FIB specimen preparation.

The focused ion beam (FIB) tool has been successfully used as both a stand alone analytical instrument and a means to prepare specimens for subsequent analysis by SEM, TEM, SIMS, XPS, and AUGER. In this work, special emphasis is given to TEM specimen preparation by the FIB lift-out technique. The fundamental ion/solid interactions that govern the FIB milling process are examined and discussed with respect to the preparation of electron transparent membranes. TRIM, a Monte Carlo simulation code, is used to physically model variables that influence FIB sputtering behavior. The results of such computer generated models are compared with empirical observations in a number of materials processed with an FEI 611 FIB workstation. The roles of incident ion attack angle, beam current, trench geometry, raster pattern, and target-material-dependent removal rates are considered. These interrelationships are used to explain observed phenomena and predict expected milling behaviors, thus increasing the potential for the FIB to be used more efficiently with reproducible results.

Coralline hydroxyapatite as bone substitute in orthopedic oncology.

We retrospectively reviewed the results of 71 consecutive patients managed with coralline hydroxyapatite (Pro-Osteon 500; Interpore Cross International) for bone defects produced as a result of surgical extirpation of bone tumors. All patients underwent a thorough physical examination and a radiographic evaluation at baseline and follow-up by the same senior surgeon (R.B.I.). Seventy-one patients were followed up for an average of 2.4 years (range, 8.1 months to 3.5 years); mean age of female patients was 39.8 years and that of male patients was 30 years. The functional status of patients at follow-up was evaluated based on comparison with preoperative functional status. Radiographic evaluation was performed and graded as follows: stage I (obvious margins), stage II (hazy margins), and stage III (obvious incorporation). The average time of return of preoperative function was 7.6 weeks. There were 3 major and 9 minor complications. We conclude that coralline hydroxyapatite graft in the form of Pro-Osteon 500 is a viable option for the management of bone defects in orthopedic oncology.

Applications of the FIB lift-out technique for TEM specimen preparation.

A site-specific technique for cross-section transmission electron microscopy specimen preparation of difficult materials is presented. A focused ion beam was used to slice an electron transparent membrane from a specific area of interest within a bulk sample. Micromanipulation lift-out procedures were then used to transport the electron-transparent specimen to a carbon-coated copper grid for subsequent TEM analysis. The FIB (focused ion beam) lift-out technique is a fast method for the preparation of site-specific TEM specimens. The versatility of this technique is demonstrated by presenting cross-sectioned TEM specimens from several types of materials systems, including a multi-layered integrated circuit on a Si substrate, a galvanized steel, a polycrystalline SiC ceramic fiber, and a ZnSe optical ceramic. These specimens have both complex surface geometry and interfaces with complex chemistry. FIB milling was performed sequentially through different layers of cross-sectioned materials so that preferential sputtering was not a factor in preparing TEM specimens. The FIB lift-out method for TEM analysis is a useful technique for the study of complex materials systems for TEM analysis.

Low-grade central osteosarcoma resembling fibrous dysplasia. A report of two cases.

We describe 2 cases of low-grade central osteosarcoma mimicking fibrous dysplasia and present a review of the literature. These cases illustrate the importance of obtaining a large representative sample of tumor in suspicious lesions, because it may be difficult or impossible to histologically distinguish low-grade central osteosarcoma from a benign lesion with limited samples from a core biopsy or needle aspiration. The treatment of choice for low-grade central osteosarcoma is resection with wide surgical margins or, if limb salvage is not technically feasible, amputation.

Aneurysmal bone cyst of the patella.

Aneurysmal bone cysts are uncommon lesions accounting for less than 1% of reported primary bone tumors. This case study reports the ninth primary aneurysmal bone cyst of the patella, and the second to be reported in a white male patient. The scarcity of reports in this vulnerable site may refute trauma as the cause. If the articular surface is spared, this lesion can be treated successfully by curettage and bone grafting, once a definitive diagnosis is made.

An unusual presentation of telangiectatic osteosarcoma.

Telangiectatic osteosarcoma (TOS) is a rare subtype of osteosarcoma that accounts for approximately 2% of all osteosarcomas. Presented is a case of a sacral mass that was originally thought to be a chordoma and was treated surgically but on pathologic examination was diagnosed as a TOS. A review of the literature on other sacral lesions is provided. The intention for presenting this case is twofold: to make physicians aware of the differential diagnoses of sacral lesions and to report an unusual presentation of this rare tumor.

MR imaging of myositis ossificans: variable patterns at different stages.

Five patients with a palpable mass at presentation underwent magnetic resonance (MR) imaging. The final diagnosis was myositis ossificans (MO). MR imaging features, particularly after injection of gadopentetate dimeglumine, mimicked those of an inflammatory mass or neoplasm. The lesions were excised in three patients, and the images were correlated with histologic findings. Three different appearances were noted on MR images, corresponding to the stages of maturation of MO. Two cases involved early-stage lesions, and T1-weighted MR images showed a mass with homogeneous intermediate signal intensity. Both lesions showed rim enhancement after contrast agent injection and high signal intensity on T2-weighted images. Pathologic specimens demonstrated stroma with masses of spindle cells in which osteoid production was interspersed. The enhanced rim of the lesion mimicked the expected MR appearance of an abscess or necrotic tumor. Areas of enhancement in adjacent muscle were also seen on postcontrast T1-weighted images. Intermediate-stage MO was present in one case; there was evidence of a thin rim of calcification on plain radiographs and fatty changes in the lesion on T1-weighted images, corresponding with histologic findings. One case of a mature lesion showed a considerable degree of peripheral calcification both on MR images and at histology. MR imaging is nonspecific in the diagnosis of early-stage MO.

Clear cell sarcoma presenting as an interdigital neuroma.

The incidence of malignant soft-tissue sarcomas in the general population is approximately 1.4 per 100,000. Approximately 2% of all cancer deaths are attributable to these tumors. Presented is a case history of a soft-tissue malignant neoplasm that was originally thought to be an interdigital neuroma and that eventually required a modified Chopart's amputation. A review of the literature is presented on other soft-tissue malignant tumors that have an affinity for the foot and ankle. The intention of presenting this case is to caution physicians that malignant lesions can simulate a benign process and should always be considered in the differential diagnosis of any foot mass.

Osteolytic monostotic Paget's disease of the fifth lumbar vertebra. A case report.

Osteolytic monostotic Paget's disease or osteitis deformans of the fifth lumbar vertebra occurred in a 55-year-old woman. An isolated lytic process involving the entire vertebral body and posterior elements and an open biopsy showed extensive remodeling with cement lines, myelofibrosis, and osteoclastic resorption typical of Paget's disease.

Mediator release in local heat urticaria: protection with combined H1 and H2 antagonists.

Two patients with local heat urticaria were examined for evidence of histamine release and for changes in mast cell morphology after local heat challenge. Both patients demonstrated significant release of histamine into the draining venous blood in the challenged arm. Biopsy specimens revealed mucosal edema after 30 min, followed by a mononuclear, perivascular infiltrate by 6 hr, and increasing in intensity by 24 hr. Degranulated mast cells were observed by electron microscopy. Heat challenge was repeated after treatment with hydroxyzine, cimetidine, or a combination of both drugs. Neither hydroxyzine nor cimetidine alone affected the clinical response to challenge, but both drugs together completely abolished the clinical response. In addition, the combination of both drugs taken regularly completely prevented symptoms. This observation suggests that histamine is one of the major mediators of this disorder and that both H1 and H2 receptors are operative.

Video self-confrontation in speech pathology.

Fifteen students in speech pathology observed and reacted to video replay of clinical sessions, representing presituation and postsituation tests with intervening microtherapy sessions, which were also videotaped and replayed. Reactions to video replays were made to questions. Experience through microtherapy and video self-confrontation gives more evidence of reduction of anxiety. Further study of the concerns of clinical trainees through video self-confrontation in a microtraining format is recommended.

Training speech pathologists through microtherapy.

Two microtraining methods were evaluated for training speech pathologists in the acquisition of skills utilized in treating misarticulations. Fifteen subjects in an introductory class in speech pathology were randomly placed in two groups (modeling, video replay, and counseling versus video replay and counseling). The training included reading a manual about the skills and a sequence of three teach sessions. The control group did not view the video model. According to the results, the model group made a greater gain score (M = 8.38) than the nonmodel group (M = 3.88). Significant gains were made for both experimental groups between teach sessions one and two, but no significant gains were made between the second and third teach sessions.

Orthopedic injuries in water-skiing: etiology and prevention.

The inherent danger of orthopedic injury is little recognized in the extremely popular sport of water-skiing. The water-skiing equipment, the speed at which the boat is driven and the experience of the skier play a major role in the severe injuries reported here.