RESUMEN
We report a case of mucosal leishmaniasis in a traveler returning from South America. The traveler developed nasal symptoms 2 months after the appearance of cutaneous ulcers. Diagnosis of mucosal Leishmania viannia braziliensis infection was made 5 years later. The clinical presentation and diagnosis for the patient are reported, and previous cases in travelers are reviewed. We recommend that mucosal examination should be part of follow-up for L. viannia braziliensis infection in travelers. Mucosal leishmaniasis should be part of the differential diagnosis of mucosal lesions in patients with a history of travel to South America, however remote the likelihood of infection.
Asunto(s)
Leishmania braziliensis/aislamiento & purificación , Leishmaniasis Mucocutánea/diagnóstico , Adulto , Animales , Humanos , Masculino , América del Sur , ViajeRESUMEN
We report the clinical course and CT and MRI findings in a case of heat-stroke-induced cerebellar atrophy. Although the cerebellar syndrome was severe concomitant with the onset of heat stroke, no abnormality was observed on brain CT in the first 2 weeks following the event. Cerebellar atrophy was first noted after 10 weeks on MRI; it was progressive during a 1-year follow-up.
Asunto(s)
Cerebelo/patología , Agotamiento por Calor/diagnóstico , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Atrofia , Daño Encefálico Crónico/diagnóstico , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Examen NeurológicoRESUMEN
PURPOSE: To determine the efficacy of silicone-covered metallic stents in the treatment of experimentally created carotid-jugular fistulas. METHODS: Carotid-jugular fistulas were surgically constructed in six mongrel dogs. Silicone-coated, self-expanding metallic stents were placed across the fistula holes within the carotid artery, and carotid angiography was performed before, immediately after, and 4 and 8 weeks after stent placement. Fistula specimens were resected 2 months after stent placement and analyzed by means of gross and light microscopy. RESULTS: Angiography revealed complete closure of all fistulas immediately after stent deployment. The fistulas remained closed and all carotid arteries remained patent. Marked stenosis within the carotid lumen was seen along the proximal and distal ends of the stents. Gross and micropathologic specimens of the carotid-jugular fistulas revealed fibrous connective tissue and collagen across the fistula holes. Proliferative fibrous connective tissue, collagen, and fibromyoblasts were located at either end of the stents. The wires of the stents indented the intraluminal surface of the carotid arteries. CONCLUSIONS: Silicone-covered stents were effective in closing all experimentally created carotid-jugular fistulas. With further refinements and variations in technique, covered stents may prove a viable alternative to current endovascular devices.
Asunto(s)
Fístula Arteriovenosa/terapia , Stents , Animales , Fístula Arteriovenosa/diagnóstico por imagen , Fístula Arteriovenosa/patología , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/patología , Perros , Venas Yugulares/diagnóstico por imagen , Venas Yugulares/patología , Metales , Radiografía , SiliconasRESUMEN
PURPOSE: To determine the efficacy of porous metallic stents in the treatment of experimentally created carotid-jugular fistulas. METHODS: Carotid-jugular fistulas were constructed surgically in five mongrel dogs. Porous metallic stents were placed endovascularly across the fistula holes within the carotid artery; carotid angiography was performed before, immediately after, and 1 and 2 months after stent placement. The fistula specimens were resected 2 months after stent placement; gross and light microscopic analyses were performed. RESULTS: Angiography revealed complete closure of three of the five fistulas 1 month after stent placement; two of the five fistulas remained patent but demonstrated diminished flow rate. All carotid arteries were widely patent throughout the study. Gross pathology of the carotid-jugular specimens revealed fibrous connective tissue and collagen within the fistula hole. A thin layer of endothelium covered the stent wires and the fibrous connective tissue overlying the fistula hole. CONCLUSIONS: The stents were effective in closing three of the five fistulas and reducing flow through the fistulas in the remaining animals. With further refinements and variations in technique, porous metallic stents may prove a viable alternative to current endovascular devices for treatment of certain arteriovenous fistulas.