Blastomycosis: Report of the first case from Alberta,Canada

The first known case of laboratory confirmed blastomycosis in Alberta occurred in 1970. The patient, who is believed never to have left Alberta, presented with of headaches, sore neck and impaired intellect. Initially, tuberculous or cryptococcal meningitis was suspected, but laboratory findings did not support the diagnosis. A fungus resembling Blastomyces dermatitidis was isolated from the venticular cerebrospinal fluid and lung at autopsy. A few yeast cells suggestive of B. dermatitidis were seen in lung and brain tissue sections. Initial attempts at in vitro conversion of the mycelial form of the isolate into yeast form on several enriched media were unsuccessful. The fungus gave ± to ++ reactions with B. dermatitidis specific conjugate by the direct fluorescent antibody technique, it was not pathogenic for mice and guinea pigs, and no asexual spores were produced in slide cultures. Further investigation indicated that the mycelial form of the fungus converted into its yeast form when an actively growing inoculum was used, although the yeast cells varied considerably in size. The yeast form produced disseminated infection in mice within 10 days. Exoantigenic analysis demonstrated an A antigen specific for B. dermatitidis, which revealed the identity of this organism as an atypical strain of B. dermatitidis.

---

Zusammenfassung Der erste Fall in Blastomycosis von einem Laboratorium wurde 1970 in Alberta bestätigt. Der Patient — der wahrscheinlich Alberta nie verlassen hat — klagte über Kopfschmerzen, Genickschmerzen und zeigte beeinträchtigte Verstand. Anfänglich wurde TBC — oder cryptococcal meningitis vermutet, laborfunde unterstutzten jedoch nicht die Diagnose. Ein Fungus — ahnlich zum Blastomyces dermatitidis wurde von venticular cerebrospinal Flüssigkeit und von der Lunge nach der Autopsie isoliert. Wenige Hefezellen hinweisend auf B. dermatitidis wurden gewebschnitten von Lunge und Gehirn festgestellt. Anfängliche Versuche die isolierten mycel Form in die Hefe Form in vitro mit Hilfe verschiedener angereicherter Nahrboden was erfolglos. Der Fungus ergab in der Direct Fluorescent Antibody Technik. ± zu ++ Reaktion mit dem B. dermatitidis specifische Konjugate; es war nicht pathogen fur Mause und Meerschweinchen, asexual Sporen wurden in der objecttrage Kultur produziert. Weitere Untersuchungen zeigten, dass sich die mycel Form des Fungus in die Hefeform umwandelte wenn ein gut wachsendes Inoculum gebraucht wurde. Die Hefezellen zeigten jedoch beträchtliche Grossenunterschiede. Die Hefeform verursachte in Mauseneine generallisierte Infektion in inerhalb von 10 Tagen. Exoantigenik Analyse zeigte ein A Antigen, specifisch für B. dermatitidis, welches die Identität des Organismus als atypischen Stamm des B. dermatitidis aufwies.

     

Acute pulmonary adiaspiromycosis. Report of three cases and a review of 16 other cases collected from the literature

We describe three cases of adiaspiromycosis with acute clinical manifestations and diffuse lung lesions. Sixteen previously reported similar cases are also reviewed. The best designation for this syndrome is acute pulmonary adiaspiromycosis.     

Blastomycosis in a Papanicolaou Smear. Report of a case with possible venereal transmission

An incidental case of cervical blastomycosis discovered by examination of a Papanicolaou smear is reported. Examinations revealed no other focus of blastomycosis in the patient. Since her husband was undergoing treatment for disseminated blastomycosis involving the lungs and prostate at the time the fungus was found, this case may represent venereally transmitted blastomycosis.     

Staphylococcus aureus cholecystitis: a report of three cases with review of the literature

Infection of the hepatobiliary system is most commonly due to enteric bacteria. We report three unusual cases of acute cholecystitis in which Staphylococcus aureus was the primary pathogen. Infection of the gallbladder with this organism has been rarely described and may be associated with gallstones and obstructive disease as well as acalculous cholecystitis in the setting of staphylococcal bacteremia and endocarditis. Two of our patients had multiple chronic medical conditions and were infected with oxacillin-resistant S. aureus (ORSA) suggesting nosocomial acquisition. Including our cases with a review of the literature, three of nine reports of S. aureus cholecystitis were associated with infectious endocarditis. Thus, the finding of S. aureus cholecystitis with bacteremia is rare and should prompt an investigation for a possible endovascular focus of infection.     

Myxoid malignant melanoma. Report of three cases and review of the literature

Three cases of malignant myxoid melanomas are described. That feature may simulate other malignant tumors with myxoid changes, especially in amelanotic metastases. The problems of differential diagnosis are briefly discussed.     

Drug resistance in malaria: three cases and a review.

Drug resistance has been well documented in two species of malarial parasites. Of greatest concern are the rapid developments in the resistance of Plasmodium falciparum to commonly used therapeutic and chemoprophylactic agents. This species, which is capable of producing life-threatening disease, has shown various levels of resistance in different parts of the world. Also, some strains of the most common species causing relapsing disease, P. vivax, exhibit resistance to primaquine. Three cases of malaria that demonstrate various types of drug resistance are presented in this paper.     

Congenital coronary artery-left heart fistulas: Report of three cases

Of 59 patients who underwent operative correction of congenital coronary artery fistulas from May 1956 through May 1980 at our institution, three had fistulas that arose from the coronary artery and terminated in the left heart. The chief indication for surgical correction in such patients is the presence of symptoms or the development of complications, which include rupture, endocarditis, and congestive heart failure. The principal objective of repair is closure or obliteration of the fistulous communication and preservation of distal myocardial perfusion. Because symptoms and complications tend to occur with age, elective ligation is warranted during childhood, even in asymptomatic patients. The three cases described here, as well as the reviewed series of left heart fistulas, substantiate this fact. All three patients were symptomatic before operation and asymptomatic afterward.     

Report of three cases that received maintenance treatment with risperidone as a mood stabilizer

INTRODUCTION: The current study is a short report of 3 cases of bipolar patients. MATERIAL AND METHODS: Three bipolar patients were prospectively followed up. All were partial responders to lithium therapy alone, and unresponsive to other therapies (anticonvulsants, antidepressants, typical antipsychotics, various combinations). RESULTS: All manifested complete remission of symptoms after combination therapy with lithium (plasma levels above 0.8 mEq/lt) plus 1-3 mg of risperidone daily. The two of them are still free of symptomatology during the maintenance period for 28 and 38 months respectively. The third patient, after several months during which she was free of symptomatology discontinued lithium against the psychiatrist's advise and received only 3 mg of risperidone daily. For the next 15 months the patient was under risperidone monotherapy and free of symptomatology. She discontinued therapy to become pregnant, the illness recurred several times during pregnancy and after the delivery the patient restarted risperidone therapy. She was free of symptoms for the following 9 months until her last follow-up. DISCUSSION: The current study provides preliminary evidence concerning the long term efficacy of risperidone in the treatment of bipolar patients     

11q- syndrome: three cases and a review of the literature.

We report on three children with de novo terminal deletions of the long arm of chromosome 11 (11q-) and breakpoints in 11q23-q24. Eighty-nine other patients with partial monosomy 11q have been reported and were reviewed by us. Salient features of 11q- syndrome are psychomotor retardation, trigonocephaly, telecanthus/hypertelorism, broad depressed nasal bridge, micrognathia, low set abnormal ears, cardiac anomalies and hand/foot anomalies. Renal agenesis and anal atresia are reported first here. Supratentorial white matter abnormality on CT and MRI present in our second patient was reported in three patients. Increased mortality is caused by cardiac anomalies. A third of all patients with partial monosomy 11q had thrombocytopenia or pancytopenia and this seems to be related to the absence of band 11q23-q24. Seventy-six percent of patients have de novo deletions with breakpoints in 11q21-q25. There is no obvious correlation between the length of the deleted segment and the severity of the symptoms. In unbalanced chromosomal patterns with deletions of 11q involving bands 11q23-q24 the typical phenotype of 11q- syndrome remains recognizable. Deletions distal to 11q24.1 do not produce the typical 11q- syndrome.     

Animal rhinosporidiosis in Brazil. Report of three additional cases

Fifteen cases of animal rhinosporidiosis seen in Brazil are briefly reviewed. Additional cases of the disease in two horses and one mule are reported.     

子宫内膜鳞状细胞癌-3例报告及文献复习

目的:探讨PSCCE的临床病理特点.方法:总结3例PSCCE的临床、病理及免疫组化特点,结合文献进行复习.结果:3例PSCCE均为绝经后妇女,临床表现与一般内膜癌相似,病理学上与其他部位鳞癌相同.免疫组化ER、PR检查仅1例PR阳性,HPV免疫染色均为阴性.2例随访患者死于诊断后11和18个月.结论:PSCCE很少见,恶性度高,预后差.与高雌激素状态和HPV关系可能并不密切.