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Ischaemic necrosis of the tongue is an unusual clinical finding. In most cases it is associated with vasculitis, particularly giant cell arteritis (GCA). Other causes include profound cardiogenic shock. We report a case of tongue necrosis in an 81-year-old Caucasian woman. The patient was admitted to the intensive care unit (ICU) for cardiogenic shock. Swelling of the tongue was reported before intubation and evolved into tongue ischaemia and necrosis of the tip of the tongue. After surgical debridement the patient recovered. To our knowledge, this is the second report of a patient surviving tongue necrosis resulting from cardiogenic shock.

Ischaemic necrosis of the tongue is an unusual clinical finding. In most cases it is associated with vasculitis, particularly giant cell arteritis (GCA). Other causes include profound cardiogenic shock. We report a case of tongue necrosis in an 81-year-old Caucasian woman. The patient was admitted to the intensive care unit (ICU) for cardiogenic shock. Swelling of the tongue was reported before intubation and evolved into tongue ischaemia and necrosis of the tip of the tongue. After surgical debridement the patient recovered. To our knowledge, this is the second report of a patient surviving tongue necrosis resulting from cardiogenic shock.

AbstractA transsexual patient has the constant and persistent conviction that he or she belongs to the opposite sex, thus creating a deeply seated gender identity conflict. With psychotherapy being unsuccessful, it has been proven that in carefully selected patients, gender reassignmentor adjusting the body to the mind (both with hormones and surgery) is the best way to normalize their lives. Optimal treatment of these patients requires the multidisciplinary approach of a gender team with the input of several specialties. Such a team consists of a nucleus of physicians who sees the patient more frequently: the psychiatrist, the endocrinologist, the plastic surgeon, the gynecologist and the urologist and a more peripheral group that sees the patients more incidentaly: the psychologist, the otorhinolaryngologist, the dermatologist, the speech therapist, the lawyer, the nurse and the social worker.Between 1987 and 1999, a total of 71 male-to-female (MTF) and 54 female-to-male transsexuals have undergone gender confirming surgery in our hospital. This article gives a review and an update on the different surgical procedures as well as on the outcome in our patient population. The results in this series of patients clearly demonstrate that a close cooperation of the different surgicalspecialties, within our multidisciplinary gender team, is the key to success in treating transsexual patients.

This phase I pilot study reports on (1) the safety and feasibility of 99Tcm-HL91, an amine oxime core radioligand that has shown oxygen dependent binding, and imaging; and (2) its usefulness for the visualization of local tumour recurrence of a biopsy proven squamous cell carcinoma of the head and neck (SCCHN) as compared to spiral computed tomogaphy (CT) and biopsy. Nine men (mean age 33 years, range 34-74 years) were prospectively included. For safety measurements, vital signs were recorded and serum chemical analysis carried out, with a complete blood cell count and urine analysis, and an ECG was performed prior to injection of 99Tcm-HL91 and repeated during the investigation. Single photon emission computed tomography (SPECT) scans of the head and neck, and of a standard, were performed at 2 h and 4 h post-injection of 740 MBq 99Tcm-HL91. Tumour-to-normal tissue background (TN) ratios and percentage uptake were measured for all 99Tcm-HL91 scans. Spiral CT scans were obtained using a Somaton 4 Siemens scanner within 1 week from the 99Tcm-HL91 scans. Based on CT and the 99Tcm-HL91 scan findings guided biopsies were performed. No adverse or subjective side effects were noticed. Vital signs, ECG findings, clinical laboratory, blood and urine assays remained stable in all patients. Spiral CT suggested local recurrence in 59 patients accompanied by nodal involvement in three, all of which proved positive on biopsy. 99Tcm-HL91 scintigraphy was false positive in one patient and true positive (TP) in 35 local recurrences and two out of three sites of lymph node involvement depicted by spiral CT. The mean TN ratios at 2 h and 4 h in TPs were 1.28 (range 1.1-1.66) and 1.40 (range 1.0-1.6), respectively. The corresponding absolute percentages of 99Tcm-HL91 lesional uptake at 2 h and 4 h were μ 0.05 (SD 0.03) and μ 0.048 (SD 0.035). The findings suggest 99Tcm-HL91 is a safe radioligand and that metabolic binding in a large fraction but not all of local SCCHN recurrences may be expected. The inference that tumour 99Tcm-HL91 avidity could be a non-invasive measure of tumour hypoxia deserves however independent confirmation with needle oximetry.

ABSTRACTA rapid enzymatic two-step test for the presumptive differentiation of four Candidaspecies commonly occurring in various clinical samples is described. The technique involves membrane filtration of a liquid sample, followed by preincubation of the membrane filter on Sabouraud glucose agar supplemented with ticarcillin-clavulanic acid to yield microcolonies. In a separate assay step, parts of the filter are placed on absorbent pads impregnated with fluorogenic 4-methylumbelliferyl (4-MU) enzyme substrates (4-MU-N-acetyl-ß-d-galactosaminide, 4-MU-phosphate, 4-MU-pyrophosphate, and 4-MU-ß-d-galactoside) in combination with 0.1% digitonin acting as a membrane permeabilizer. The membrane filter in contact with the assay medium is incubated to allow cleavage of the enzyme substrate, resulting in fluorescent microcolonies under long-wavelength UV light. This approach, tested on 301 clinical samples, is able to presumptively differentiate C. albicans, C. glabrata, C. krusei, and C. tropicalisand to distinguish them from other Candidaspp. in about 9 to 11 h. Overall agreement with the conventional methods of 94.4% (one Candidaspecies present in the sample) to 83.8% (multiple Candidaspp. present) was obtained. The false-negative rates with reference to identification by traditional methods were 1.3% (single species) and 3.8% (multiple species).

Epidermolysis bullosa acquisita (EBA) is an acquired subepidermal blistering disease associated with autoantibodies against type VII collagen. The classical or mechanobullous form of EBA is characterized by skin fragility, trauma-induced blisters and erosions with mild mucous membrane involvement and healing with scars. Furthermore, bullous-pemphigoid-like and cicatricial pemphigoid-like features have been described. We report a patient who developed a bullous skin disease with upper airway obstruction requiring tracheotomy. The diagnosis of EBA was established by immunoblot, showing a band at 290 kD (collagen VII), and NaCl-split skin immunofluorescence (IgG deposition at the floor of the split). This case presented with clinical features of both bullous pemphigoid and cicatricial pemphigoid which to our knowledge is the first report of such a combination in EBA. The patient also presented tracheal involvement that has never been described either.

To report a single-center experience of compassionate use of amphotericin B lipid complex (ABLC) in patients with proven or suspected fungal infection who were or would have been unable to tolerate conventional amphotericin B.

Objective: To report a single‐center experience of compassionate use of amphotericin B lipid complex (ABLC) in patients with proven or suspected fungal infection who were or would have been unable to tolerate conventional amphotericin B.

Gene expression in pea roots grown in a medium with a low oxygen concentration was compared with that in nitrogen-fixing pea root nodules induced by Rhizobium bacteria. The results show that during microaerobiosis the expression of eight genes is increased. None of these belong to the group of genes earlier identified as nodulin genes. On the other hand, no enhanced transcription of microaerobic genes can be detected during nodule development and hybridizations of Northern blots, containing nodule RNA and RNA isolated from oxygen-stressed roots, show that the alcohol dehydrogenase genes are not expressed at a higher level in pea root nodules whereas a higher expression is observed during microaerobiosis. From these observations it can be concluded that it is unlikely that a low concentration of free oxygen induces the expression of nodulin genes. Furthermore, genes that are activated as a result of oxygen deficiency are not expressed in pea root nodules, indicating that if the concentration of free oxygen is low the nodule cells do not suffer under microaerobic conditions. Probably, leghemoglobin functions as an efficient oxygen buffer for the energy-generating process in both the plant cells and the bacteroids.

Tracheoesophageal voice prostheses in laryngectomized patients commonly deteriorate due to the presence of yeasts, particularly Candidaspecies. We describe the first case of colonization of such a device by Cryptococcus neoformansin a patient with a history of glottic carcinoma. The isolate showed an identical genomic pattern with C. neoformansfrom pigeon excreta in the patient's environment.

Abstract: We report a schwannoma with a rare location at the tip of the nose in a 20-year-old woman with an otherwise unremarkable medical history. The imaging findings unterline the usefulness of MRI in narrowing down the differential diagnosis of masses in this region. Once the diagnosis was focussed on a neural origin of the mass, the exact nature of the tumour could not be predicted from the MRI, although the presence of a capsule on imaging studies as well as at operation suggested it was probably a schwannoma. A schwannoma must be considered when one encounters a sharply delineated mass at the tip of the nose, showing high signal on T2-weighted images and strongly contrast enhancement.

Abstract.: We report a rare case of a young girl with an embryonal rhabdomyosarcoma of the right aryepiglottic fold. Local disease recurrence, occurring 7 years after subtotal resection and adjuvant chemotherapy, was studied with plain radiography, CT and MRI. To the best of our knowledge, this is the first report illustrating the MRI characteristics of a laryngeal embryonal rhabdomyosarcoma in a child.

La réinnervation sélective des muscles laryngés par la racine d’un nerf phrénique permet d’améliorer la ventilation en préservant la voix. Les succès obtenus permettent d’étendre les indications aux patients déjà traités par voie endoscopique. Serait-elle applicable à la réinnervation fonctionnelle d’un transplant laryngé ?

Tracheoesophageal voice prostheses in laryngectomized patients commonly deteriorate due to the presence of yeasts, particularly Candida species. We describe the first case of colonization of such a device by Cryptococcus neoformans in a patient with a history of glottic carcinoma. The isolate showed an identical genomic pattern with C. neoformans from pigeon excreta in the patients environment.