Aggressive and atypical manifestations of Erdheim-Chester disease.

Erdheim-Chester disease (ECD) is a disseminated non-Langerhans' cell histiocytosis with multisystem involvement, including characteristic sclerotic musculoskeletal lesions. We present the case of a 27-year-old woman with a fulminant course and atypical involvement by ECD manifesting as extensive cerebrovascular disease and lytic musculoskeletal lesions. This case represents an unusual and aggressive presentation of ECD owing to the patient's young age, the severity of the cerebrovascular involvement and the lytic osseous lesions.

MR imaging of infiltrative muscle involvement with Langerhans cell histiocytosis.

Langerhans cell histiocytosis (LCH) consists of three clinical syndromes of varying severity resulting from basic cellular defect leading to lipid deposition within histiocytes. Radiologically, bone lesions are similar in all three forms of LCH and are due to bone destruction. An eosinophilic granuloma of the bone can involve skeletal muscle by direct extension from the bone. However, skeletal muscle involvement is rare and is not reported on MR imaging previously in the English literature. Our case not only shows biopsy-proven muscle involvement by LCH but also reports the first diffuse nodular pattern of muscle involvement by LCH.

Obstructive sleep apnea, hypoxia, and metabolic syndrome in psychiatric and nonpsychiatric settings.

Obesity continues to be a serious cause of morbidity and mortality globally and particularly in North America. Primary manifestations of obesity include obstructive sleep apnea (OSA) and depression associated with a decrease in immune defense mechanisms, possibly related to increased cytokine levels. Secondary manisfestations of obesity possibly result from a cascade of events and include insulin resistance/ hyperglycemia, hyperlipidemia, and hypertension-all of which comprise metabolic syndrome. This paper reviews sleep disturbances in general and OSA in psychiatric patients, particularly those who are obese.

Blood brain barrier: the role of calcium homeostasis.

Calcium as a molecule plays a significant role in the body, especially in the central nervous system. In its free form, it has been classified as a cofactor, second messenger, and signaling molecule, and, when bound, forms a protein and coenzyme. This is secondary to the critical, and at times, very sensitive reactions associated with it. Calcium homeostasis, especially in the context of the central nervous system, may have crucial implications in many neuropsychiatric conditions. The hypothesis presented will explore the link between the blood-brain barrier (BBB) and calcium homeostasis (CH) as it is a complex, physiological process. Absence of organic deficits associated with conditions, such as pervasive developmental disorder (PDD), autism spectrum disorders (ASD), mental retardation (MR), and attention deficit hyperactivity disorder (ADHD), in addition to other chronic psychiatric disorders, builds a more compelling case to explore CH in context of the BBB.

Anaerobic osteomyelitis of femoral head with intraosseous, intra-articular, bursal and muscle pneumatosis.

A case is presented of anaerobic osteomyelitis with intraosseous pneumatosis resulting in extension of gas in soft tissue structures and femur in a patient with mitral valve vegetation and bacteremia. The finding of intraosseous pneumatosis and its extension into the hip joint, iliopsoas bursa and subgluteus medius bursa is depicted. Intraosseous pneumatosis is a rare but concerning finding for osteomyelitis in the absence of a penetrating wound, recent surgery, biopsy or fracture.

Malignant transformation of fibrous dysplasia into chondroblastic osteosarcoma.

A case of malignant transformation of polyostotic fibrous dysplasia into maxillary chondroblastic osteosarcoma is presented. The clinical, radiographic, CT, MR imaging features and pathological findings of polyostotic fibrous dysplasia and its malignant transformation are described. Malignant transformation of fibrous dysplasia is rare and has not previously been described in the English literature in this location in McCune-Albright syndrome and in the absence of radiation treatment.

Spectral Doppler sonography of musculoskeletal soft tissue masses.

OBJECTIVE: To determine whether resistive indices obtained from spectral Doppler waveforms can be used to distinguish benign from malignant musculoskeletal soft tissue masses. METHODS: A retrospective review of Doppler sonograms was performed for 52 patients with 53 soft tissue masses. All masses showed internal flow on color or power Doppler sonography, and spectral Doppler sonography yielded waveforms from which resistive indices were calculated. This information was analyzed along with the histologic diagnosis of each lesion with significance set at P > .05. RESULTS: There were 19 benign lesions and 34 malignancies. The resistive indices of the benign masses ranged from 0.44 to 1.0 (mean +/- SD, 0.72 +/- 0.42), whereas the malignant masses had resistive indices ranging from 0.28 to 1.0 (mean, 0.62 +/- 0.36). There was no statistically significant (P > .05) difference between the resistive indices of benign and malignant lesions. CONCLUSIONS: Resistive indices cannot be used to distinguish benign from malignant musculoskeletal soft tissue masses.

Granulomatous myositis: a manifestation of chronic graft-versus-host disease.

A case of granulomatous myositis as a manifestation of chronic graft-versus-host disease is presented. The clinical presentation, MR imaging appearances, pathologic features and excellent response to treatment with immunosuppression are described. To the best of our knowledge, based on a world literature search, this is the first report of graft-versus-host disease presenting as granulomatous polymyositis.,

Mycotic osteomyelitis due to Scedosporium Apiospermum: MR imaging-pathologic correlation.

Mycotic osteomyelitis is rare and occurs in immunocompromised patients after inoculation of the pathogen at a penetrating trauma site. Mycotic osteomyelitis due to Scedosporium Apiospermum is extremely rare, with only 13 cases of septic arthritis reported previously. Ours is only the third case of S. apiospermum osteomyelitis in an immunocompromised patient and the only patient with a histopathologic diagnosis from an amputation specimen. Recognition of this pathogen may be delayed due to insidious onset and negative joint fluid cultures, often requiring synovial or bone biopsies to establish the diagnosis. Delay in appropriate treatment may result in disseminating infection or even death.

Influence of a new prophylactic antibiotic therapy on the incidence of liver abscesses after chemoembolization treatment of liver tumors.

Intrahepatic abscess is a complication of transcatheter arterial chemoembolization (TACE) treatment in patients who have a history of biliary reconstructive surgery. This study followed eight patients who underwent chemoembolization after biliary surgery. These patients were divided into two groups. Patients in group one (n = 4) were administered intravenous cephalexin for prophylaxis. Patients in group two (n = 4) were administered bowel preparation and tazobactam/piperacillin. All patients in group one developed hepatic abscesses, which were treated with percutaneous catheter drainage and antibiotics. None of the patients in group two developed abscesses. Aggressive antibiotic prophylaxis with bowel preparation may provide protection against intrahepatic abscesses after chemoembolization in patients who have a history of biliary reconstructive surgery.