[Retropharyngeal calcific tendinitis-An underestimated cause of acute neck pain]. / Retropharyngeale Tendinitis ­ eine unterschätzte Ursache akuter Nackenschmerzen.

BACKGROUND: Retropharyngeal calcific tendinitis is an aseptic inflammation of the longus cervicis muscle. This rare acute pain disorder of the neck region is a prognostically benign condition compared to neurological or otorhinolaryngological differential diagnoses. OBJECTIVE: To capture the clinical appearance, diagnostics, treatment and course of this rare disease. MATERIAL AND METHODS: In this retrospective monocentric observational study, demographic, clinical, paraclinical as well as treatment and follow-up data of all inpatients with a diagnosis of retropharyngeal calcific tendinitis admitted to the Diako Hospital Mannheim in the years 2018 to 2021 were analyzed. RESULTS: This study included four female and one male patient with an age between 36 years and 77 years. Severe neck pain with restriction of cervical spine rotation was the leading clinical appearance, in four out of five patients there was a painful swallowing disorder. Inflammatory markers were elevated in four patients. Characteristic MRI or CT imaging alterations of the cervical spine confirmed the diagnosis. The symptoms resolved within 4-14 days after treatment with nonsteroidal anti-inflammatory drugs (NSAID) and four patients additionally received glucocorticoids. No recurrences were observed during the follow-up period of 5-30 months. CONCLUSION: The good prognosis of this rare disease is reflected by the rapid remission of symptoms under NSAIDs and glucocorticoids and by the absence of recurrences during follow-up. CT or MRI imaging is required to rule out differential diagnoses, and to confirm the characteristic imaging alterations of retropharyngeal calcific tendinitis. Additionally, cerebrospinal fluid puncture and otorhinolaryngological assessment may be necessary in some cases.

Stroke seasonality associations with subtype, etiology and laboratory results in the Ludwigshafen Stroke Study (LuSSt).

Data on seasonal differences in stroke incidence are conflicting. Little is known about seasonal variability in etiological stroke subtypes and population-based data on possible trigger factors are lacking. The Ludwigshafen Stroke Study is a prospective population-based stroke registry. All residents of the city of Ludwigshafen who suffer from acute stroke or TIA are registered. Patients with first-ever stroke (FES) were included for the present analysis. Between January 1, 2006 and December 31st, 2010, 1,779 patients (age 71.7 ± 13.4 years (mean + standard deviation; 897 (50.4 %) women) suffered a FES. Incidence for FES was lowest in summer (reference) with significantly higher rates in winter (rate ratio (RR) 1.20, 95 % confidence interval (CI) 1.05-1.37) and spring (RR 1.21 95 % CI 1.06-1.38). First-ever ischemic stroke (FEIS) was more common in winter (RR 1.16, 95 %CI 1.01-1.34) and first-ever intracerebral haemorrhage (FE-ICH) was more frequent in spring (RR 2.0, 95 %CI 1.24-3.22) than in summer. In FES, systolic and diastolic blood pressure on admission (SBP/DBP) showed significant variation with lowest values in summer (SBP: p = 0.02; DBP p = 0.05). In subtypes of FEIS, cardioembolism tended to be more common in winter (p = 0.14). There were no differences in risk factor prevalence between seasons. Leukocyte count on admission was lowest in summer (8.2 ± 1.4/µl) and highest in winter (8.9 ± 1.9/µl; p = 0.008). The hematocrit showed a similar trend (p = 0.06). Our data show higher incidence rates for FES in winter and spring, for FEIS in winter and for FE-ICH in spring. Variations in blood pressure on admission and leukocyte counts were associated with these findings and may possibly contribute to seasonal stroke variability.

A one-pot synthesis of 3-trifluoromethyl-2-isoxazolines from trifluoromethyl aldoxime.

Functionalized 3-trifluoromethyl-2-isoxazolines and 3-trifluoromethylisoxazoles were easily prepared from trifluoromethyl aldoxime 2 under mild conditions by using DIB as oxidant. Theoretical studies of the reactivity of trifluoroacetonitrile oxide 4 toward olefins and alkynes were carried out. The 3-trifluoromethyl-2-isoxazolines were ring-opened with NaBH4 and NiCl2 to yield the corresponding trifluoromethylated γ-amino alcohols.

Multifocal leukoencephalopathy associated with intensive use of cocaine and the adulterant levamisole in a 29-year old patient.

Levamisole is a common adulterant of cocaine and has been associated with reversible leukoencephalopathy in cocaine users. We report a case of two episodes with severe neurological symptoms and multifocal white matter lesions with brainstem and cerebellar involvement in a 29-year-old man after sporadic cocaine consumption. A urinalysis was positive for levamisole. Neurological deficits as well as MRI presentation improved after cessation of levamisole exposure and two courses of intravenous high-dose glucocorticoid therapy. Early diagnosis of levamisole-induced multifocal leukoencephalopathy and treatment with corticosteroids without delay is essential for a good recovery from neurological symptoms. Although cocaine is one of the most prevalent abused illicit drugs, cocaine- and levamisole-induced multifocal leukoencephalopathy is underdiagnosed as this disorder is not often described in the literature and anamnesis of drug abuse is not admitted by the patient. Therefore, an additional screening for cocaine and levamisole in clinical practice is useful in similar cases to support the diagnosis.