Schwannoma of the common peroneal nerve – a rare incidence

Schwannomas are benign tumours arising from neurilemmal cells which forms the myelin sheath of peripheral nerves. It usually occurs in the head, but may be found in the brachial plexus and sciatic nerve. Common peroneal nerve schwannoma are rare. We report a case of a middle age gentleman who presented with pain and swelling over the right popliteal fossa with associated right radicular pain of the anterolateral leg and weakness of ankle dorsiflexion. Examination revealed a 3x2 cm lump behind the posterolateral aspect of the right knee with positiveTinel’s sign upon tapping of the lump, sensory deficit over the anterolateral aspect of the leg and the ankle dorsiflexors had a muscle power of grade 3. Magnetic resonance imaging (MRI) of the right leg revealed a well circumscribed, oval lesion located along the pathway of the common peroneal nerve homogenously hypointense on T1-weighted images and heterogeneously hyperintense on T2 weighted images compared to the muscles. The lesion was not surpressed on fat suppression sequences. Intra-operatively, we noted that the schwannoma was in continuity with the common peroneal nerve. The patient underwent excision of the schwannoma. Post operatively, the pain reduced remarkably but patient suffers from numbness and right foot drop as a complication of the tumour. This case highlights the rarity of common peroneal nerve schwannoma which presents with neuropathic symptoms complicated with right foot drop

inVestIgating the pSychologIcal and ecONomic impAct of cataRact surgerY in Vietnam: The VISIONARY observational study protocol

<p>Abstract</p> <p>Background</p> <p>Visual impairment caused by cataracts not only affects an individual's quality of life but can also have a profound impact on other important psychological factors and on the economic circumstances of individuals and their households. Cataract surgery is an effective intervention to restore vision and is also associated with other positive consequences including improvements in quality of life, economic and psychological outcomes. While there has been an increase in the number and quality of cataract surgeries performed in Vietnam, the programs currently in place are still unable to meet the existing demand and need for surgery. Data on both the cost-effectiveness of cataract surgery and the economic and psychological impact of untreated cataract in this setting is lacking.</p> <p>Methods/Design</p> <p>This study, investigating the psychological and economic impact of cataract surgery in Vietnam (VISIONARY), will recruit and interview a sample of adults (18 years or over) who are referred for cataract surgery by one of the following sites and their outreach programs: Hue Eye Hospital; Thai Binh Eye Hospital; Binh Dinh Department of Health Eye Hospital and the Vinh Long Department of Health Social Disease Centre. All participants (those who have cataract surgery and those who do not have surgery) will be followed up at six and 12 months.</p> <p>Discussion</p> <p>This study is designed to examine the impact of low vision on household economic circumstances and psychological outcomes as well as to investigate the effectiveness and cost-effectiveness of cataract surgery in Vietnam. It will help to inform international and national non-government organisations working in the country and local policy-makers on priorities for further investment in eye-health services in this setting and their relevance to broader economic development goals.</p

Can a falling tree make a noise in two forests at the same time?

It is a commonplace to claim that quantum mechanics supports the old idea that a tree falling in a forest makes no sound unless there is a listener present. In fact, this conclusion is far from obvious. Furthermore, if a tunnelling particle is observed in the barrier region, it collapses to a state in which it is no longer tunnelling. Does this imply that while tunnelling, the particle can not have any physical effects? I argue that this is not the case, and moreover, speculate that it may be possible for a particle to have effects on two spacelike separate apparatuses simultaneously. I discuss the measurable consequences of such a feat, and speculate about possible statistical tests which could distinguish this view of quantum mechanics from a ``corpuscular'' one. Brief remarks are made about an experiment underway at Toronto to investigate these issues.Comment: 9 pp, Latex, 3 figs, to appear in Proc. Obsc. Unr. Conf.; Fig 2 postscript repaired on 26.10.9

Determinants of response to a parent questionnaire about development and behaviour in 3 year olds: European multicentre study of congenital toxoplasmosis.

Background: We aimed to determine how response to a parent-completed postal questionnaire measuring development, behaviour, impairment, and parental concerns and anxiety, varies in different European centres. Methods: Prospective cohort study of 3 year old children, with and without congenital toxoplasmosis, who were identified by prenatal or neonatal screening for toxoplasmosis in 11 centres in 7 countries. Parents were mailed a questionnaire that comprised all or part of existing validated tools. We determined the effect of characteristics of the centre and child on response, age at questionnaire completion, and response to child drawing tasks. Results: The questionnaire took 21 minutes to complete on average. 67% (714/1058) of parents responded. Few parents (60/1058) refused to participate. The strongest determinants of response were the score for organisational attributes of the study centre (such as direct involvement in follow up and access to an address register), and infection with congenital toxoplasmosis. Age at completion was associated with study centre, presence of neurological abnormalities in early infancy, and duration of prenatal treatment. Completion rates for individual questions exceeded 92% except for child completed drawings of a man (70%), which were completed more by girls, older children, and in certain centres. Conclusion: Differences in response across European centres were predominantly related to the organisation of follow up and access to correct addresses. The questionnaire was acceptable in all six countries and offers a low cost tool for assessing development, behaviour, and parental concerns and anxiety, in multinational studies

A black finger does not equal a dead finger

Revascularisation and replant surgery occasionally produces sub-optimal results. We present two cases of near total amputation of the digits. The first patient was an 11-year-old boy with a middle finger avulsion injury sustained after the finger was caught in a washing machine with the flexor digitorum profundus still attached. The second patient was a 42-year-old male who sustained a machete attack and had near total amputation of his small and ring fingers with a 2 cm skin bridge still attached. All patients underwent revascularization with repair of only one digital artery for each finger as the opposite artery was non-viable. No digital veins were repaired. Relief of venous congestion was done by pin-prick six times a day up till one week. At one week post-surgery, the fingers were discoloured black but had good pulp turgor and full contour with arterial bleed on pin-prick. Inexperienced surgeons may view this as gangrene and amputate the fingers. However, we continued observation and at one month post-surgery, the black skin had desloughed and the underlying skin was pink

Identification and Characterization of a New Orthoreovirus from Patients with Acute Respiratory Infections

First discovered in the early 1950s, reoviruses (respiratory enteric orphan viruses) were not associated with any known disease, and hence named orphan viruses. Recently, our group reported the isolation of the Melaka virus from a patient with acute respiratory disease and provided data suggesting that this new orthoreovirus is capable of human-to-human transmission and is probably of bat origin. Here we report yet another Melaka-like reovirus (named Kampar virus) isolated from the throat swab of a 54 year old male patient in Kampar, Perak, Malaysia who was suffering from high fever, acute respiratory disease and vomiting at the time of virus isolation. Serological studies indicated that Kampar virus was transmitted from the index case to at least one other individual and caused respiratory disease in the contact case. Sequence analysis of the four small class genome segments indicated that Kampar and Melaka viruses are closely related. This was confirmed by virus neutralization assay, showing an effective two-way cross neutralization, i.e., the serum against one virus was able to neutralize the other. Although the exact origin of Kampar virus is unknown, epidemiological tracing revealed that the house of the index case is surrounded by fruit trees frequently visited by fruit bats. There is a high probability that Kampar virus originated from bats and was transmitted to humans via bat droppings or contaminated fruits. The discovery of Kampar virus highlights the increasing trend of emergence of bat zoonotic viruses and the need to expand our understanding of bats as a source of many unknown viruses

The Periotest Method: Implant-Supported Framework Precision of Fit Evaluation

: In this study, the Periotest instrument was used to measure the precision of fit between cast high noble-metal frameworks and the supporting implants in a patient-simulation model. Three framework conditions and three implant-location variables were used to evaluate the rigidity of the assembly as measured by the Periotest method. The framework variables were (1) one-piece castings (OPC); (2) sectioned-soldered inaccurate castings (SSIC); and (3) sectioned-soldered accurate castings (SSAC). The implant-location variables were right anterior (RA), center (C), and left anterior (LA). Materials and Methods : The patient simulation model used consisted of three self-tapping BrÅnemark implants in a reasonable arch curvature in bovine bone. Three working casts were fabricated from the patient-simulation model using polyvinyl siloxane and tapered impression copings. From the working casts, three sets of three frameworks were fabricated as OPCs, SSICs, and SSACs using type 3 high noble alloy. The SSICs were fabricated with a quantitative misfit of 101.6 Μm at the facial surface, between the abutment-to-gold cylinder interface at the C implant location. Periotest value (PTV) measurements were made at the midfacial surface of the frameworks directly above each abutment-to-gold cylinder interface. Three measurements were made for each test condition. The data were analyzed to compare framework condition(s) and implant location(s) using ANOVA and Fisher's Protected Least Significant Difference Comparison Test. Results : The ANOVA showed that significant differences exist between the mean PTV data for framework condition and for implant location (p < .01). Significant differences were shown between the mean PTV data for the SSAC assemblies and the OPC and SSIC assemblies. The SSICs displayed a more positive (+) mean PTV than the OPCs. The OPC assemblies had a more positive mean PTV than the SSAC assemblies. The mean PTV data for the SSAC assemblies had a significantly different PTV (p < .01) than the other two framework condition assemblies. The OPC and the SSIC assemblies had PTVs that were not significantly different. The C implant location was significantly different from the RA and the LA implant locations (p < .01). The RA and the LA implant locations were not significantly different from each other. The C implant location always demonstrated the most positive mean PTV regardless of the framework condition being tested. Conclusions : The Periotest instrument quantified differences in the precision of fit between three framework conditions. The SSAC assemblies were significantly more rigid than the OPC and SSIC assemblies. The OPC and SSIC assemblies' mean PTVs were not significantly different. The mean PTVs for the C implant location and the RA and LA implant locations were significantly different (p < .01). The mean PTVs of the RA and LA implant locations were not significantly different. The implant-location PTVs followed the same rank order for all three framework conditions. The procedures used to fabricate a more precise fit between the framework and the supporting implants is influenced by the skill of the clinician and technician.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75096/1/j.1532-849X.1996.tb00298.x.pd

Developmental changes in the role of different metalinguistic awareness skills in Chinese reading acquisition from preschool to third grade

Copyright @ 2014 Wei et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.The present study investigated the relationship between Chinese reading skills and metalinguistic awareness skills such as phonological, morphological, and orthographic awareness for 101 Preschool, 94 Grade-1, 98 Grade-2, and 98 Grade-3 children from two primary schools in Mainland China. The aim of the study was to examine how each of these metalinguistic awareness skills would exert their influence on the success of reading in Chinese with age. The results showed that all three metalinguistic awareness skills significantly predicted reading success. It further revealed that orthographic awareness played a dominant role in the early stages of reading acquisition, and its influence decreased with age, while the opposite was true for the contribution of morphological awareness. The results were in stark contrast with studies in English, where phonological awareness is typically shown as the single most potent metalinguistic awareness factor in literacy acquisition. In order to account for the current data, a three-stage model of reading acquisition in Chinese is discussed.National Natural Science Foundation of China and Knowledge Innovation Program of the Chinese Academy of Sciences

Development of an Acute and Highly Pathogenic Nonhuman Primate Model of Nipah Virus Infection

Nipah virus (NiV) is an enigmatic emerging pathogen that causes severe and often fatal neurologic and/or respiratory disease in both animals and humans. Amongst people, case fatality rates range between 40 and 75 percent and there are no vaccines or treatments approved for human use. Guinea pigs, hamsters, cats, ferrets, pigs and most recently squirrel monkeys (New World monkey) have been evaluated as animal models of human NiV infection, and with the exception of the ferret, no model recapitulates all aspects of NiV-mediated disease seen in humans. To identify a more viable nonhuman primate (NHP) model, we examined the pathogenesis of NiV in African green monkeys (AGM). Exposure of eight monkeys to NiV produced a severe systemic infection in all eight animals with seven of the animals succumbing to infection. Viral RNA was detected in the plasma of challenged animals and occurred in two of three subjects as a peak between days 7 and 21, providing the first clear demonstration of plasma-associated viremia in NiV experimentally infected animals and suggested a progressive infection that seeded multiple organs simultaneously from the initial site of virus replication. Unlike the cat, hamster and squirrel monkey models of NiV infection, severe respiratory pathology, neurological disease and generalized vasculitis all manifested in NiV-infected AGMs, providing an accurate reflection of what is observed in NiV-infected humans. Our findings demonstrate the first consistent and highly pathogenic NHP model of NiV infection, providing a new and critical platform in the evaluation and licensure of either passive and active immunization or therapeutic strategies for human use