Subacute sclerosing panencephalitis: relationship between clinical stage and diffusion-weighted imaging findings

PURPOSE: To investigate the relationship between clinical stages and apparent diffusion coefficient (ADC) changes in the brain of patients with subacute sclerosing panencephalitis (SSPE). MATERIALS AND METHODS: A total of 18 patients with stage II (N = 11) and III (N = 7) SSPE and 11 age-matched controls underwent routine MRI and diffusion-weighted imaging (DWI). The ADC values were automatically calculated. Seven distinct neuroanatomic structures (frontal, parieto-occipital, and cerebellar white matter; deep white matter; thalamus; basal ganglia; and brainstem) were selected for analysis in the patient and control groups. RESULTS: Hyperintensities in the periventricular and subcortical white matters on T2-weighted images and ADC maps were detected in 63.6% of patients with stage II and in all patients with stage III. There were significant differences between stage II and III patients and also between patients and control group in ADC values that obtained from all locations. The highest mean ADC values were calculated in stage III patients. Although MRI and DWI findings were normal in four patients with stage II disease, ADC values were significantly increased when compared with controls. CONCLUSION: The stage of disorder may be independent of DWI appearance during the early stage (stages I and II), even though the brain is affected. Therefore, DWI and ADC values supplemental to routine MRI should also be utilized for lesion detection and definition to enhance diagnostic accuracy in patients with SSPE.     

Nasal septal packing: which one?

The aim of this study was to investigate the effects of four different types of nasal packs on pain, nasal fullness and postoperative bleeding following septoplasty. Prospective randomised double blind study was conducted. The study group included 119 patients who underwent endonasal septoplasty under general anaesthesia. Four types of nasal packing materials were utilized: (1) Merocel standard 8-cm nasal dressing without airway, (2) Doyle Combo splint (DCS), (3) Merocel in a glove finger and (4) Vaseline gauze. All packs were removed at the 48th hour (±3?h) after the surgery. Three different variables were investigated following the surgical procedure: (1) pain, (2) nasal fullness and (3) bleeding after removal of the nasal packing material. DCS produced the greatest pain at the first and sixth postoperative hours. At the first postoperative day, the greatest pain score was reported for Merocel in the glove finger and the least for Merocel. The pain scores during the removal of the nasal packings were highest for Merocel and lowest for Merocel in the glove finger. DCS had the lowest nasal fullness score. Bleeding ratio was highest for Merocel, followed by Vaseline gauze, DCS and Merocel in the glove finger. Many different commercially available packing materials are presently used, each with inherent advantages and disadvantages. We evaluated the pain, nasal fullness and bleeding potential of four nasal packing materials and determined that Merocel had the highest pain potential during removal and the highest rate of bleeding following removal.     

Sirolimus-based triple immunosupression with antithymocyte globulin induction in expanded criteria donor kidney transplantation

BACKGROUND: Target of rapamycin inhibitors have presented similar graft and patient outcomes with no evidence of drug-induced nephrotoxicity when compared with calcineurin inhibitors. The principal aim of this study is to demonstrate the efficacy of sirolimus-based triple immunosuppression with antithymocyte globulin induction in expanded donor kidney transplantation. METHODS: Twenty-seven primary expanded criteria donor kidney transplant recipients were recruited. The severity of kidney damage was qualified by zero-hour biopsies. Protocol biopsies were performed at 1 year to assess the chronic allograft damage. Death, graft function, proteinuria and adverse events were systematically analysed during the study period. RESULTS: The mean follow up was 20.2 months. Patient and graft survival was 100% with a mean glomerular filtration rate (GFR) of 53.1+/-4.9 mL/min at last follow up. The cumulative incidence of acute rejection was 11% at the last follow up. At 1 year, mean creatinine, GFR and proteinuria were 1.84 mg/dL, 52.3 mL/min, 651.5 mg/day, respectively. Four patients required surgical intervention due to urinary complications and recovered successfully. Two patients developed acute graft dysfunction due to acute tubular necrosis which was presumably drug related. Ten patients developed relapsing urinary tract infections and three patients had pneumonia. No infectious death occurred throughout the study period. Baseline renal structure was preserved in 13 biopsies at 1 year post transplant. Five patients demonstrated progressive but mild tubular atrophy or interstitial fibrosis in their protocol biopsies. The mean chronic allograft damage index scores at baseline and at 1 year from biopsy were 2.57+/-0.23 and 2.83+/-0.23, respectively (P=0.046). CONCLUSIONS: Low-dose sirolimus-based triple immunosuppression with antibody induction offered a safe clinical outcome in expanded criteria donor kidneys with the achievement of stable renal function and favourable recipient outcomes throughout the short term. However, mild progression of histological damage and increased risk of bacterial infection are a major concern. Additionally, the benefit (if any) of the low acute rejection rate on long-term graft outcome is still undetermined.     

Spinal glial TLR4-mediated nociception and production of prostaglandin E2 and TNF

Background and purpose:

Toll-like receptor 4 (TLR4) expressed on spinal microglia and astrocytes has been suggested to play an important role in the regulation of pain signalling. The purpose of the present work was to examine the links between TLR4, glial activation and spinal release of prostaglandin E₂ (PGE₂) and tumour necrosis factor (TNF), and the role these factors play in TLR4-induced tactile allodynia.

Experimental approach:

Toll-like receptor 4 was activated by intrathecal (i.t.) injection of lipopolysaccharide (LPS) and KDO₂-Lipid A (KDO₂) to rats. Tactile allodynia was assessed using von Frey filaments and cerebrospinal fluid collected through spinal dialysis and lumbar puncture. PGE₂ and TNF levels were measured by mass spectometry and elisa. Minocycline and pentoxifylline (glia inhibitors), etanercept (TNF-blocker) and ketorolac (COX-inhibitor) were given i.t. prior to injection of the TLR4-agonists, in order to determine if these agents alter TLR4-mediated nociception and the spinal release of PGE₂ and TNF.

Key results:

Spinal administration of LPS and KDO₂ produced a dose-dependent tactile allodynia, which was attenuated by pentoxifylline, minocycline and etanercept but not ketorolac. Both TLR4 agonists induced the spinal release of PGE₂ and TNF. Intrathecal pentoxifylline blunted PGE₂ and TNF release, while i.t. minocycline only prevented the spinal release of TNF. The release of PGE₂ induced by LPS and KDO₂ was attenuated by i.t. administration of ketorolac.

Conclusions and implications:

Activation of TLR4 induces tactile allodynia, which is probably mediated by TNF released by activated spinal glia.     

Associations between first-trimester uterine artery Doppler velocimetry indices and adverse perinatal outcomes in women conceiving via in vitro fertilization

Aim: To explore if first-trimester uterine artery Doppler velocimetric values might predict adverse perinatal outcomes in patients conceiving via in vitro fertilization (IVF).

Methods: We evaluated pregnancies in women who conceived via IVF (Group 1, n?=?62) and compared these subjects to a control group (spontaneous pregnancies; Group 2, n?=?53) in terms of first-trimester uterine artery Doppler velocimetric data. We explored whether these data predicted adverse perinatal outcomes (need for cesarean delivery, preterm birth, low birth weight, lower APGAR score, and need for referral to a neonatal intensive care unit [NICU]).

Results: The mean age of Group 1 patients was 29.9?±?4.7 years and that of Group 2 was 27.2?±?4.2 years. Gestational age at birth, first-minute APGAR scores, NICU referral rate, birth weight, preterm birth rate, abortion rate, delivery type, the left-side uterine arterial systole–diastole ratio (LUASD), the left-side uterine arterial resistance index (LUARI), the right-side uterine arterial systole–diastole ratio (RUASD), and the right-side uterine arterial resistance index (RUARI) differed significantly between the two groups (all p values < 0.05). In the study group, positive correlations were evident between LUASD, LUARI, RUASD, and RUARI, preterm birth rates, and NICU referral rates. Also, birth weight correlated negatively with LUASD, LUARI, RUASD, and RUARI in the study group.

Conclusions: First-trimester uterine artery Doppler velocimetric indices, including the resistance index and systole–diastole ratio, usefully predict adverse perinatal outcomes of IVF pregnancies.     

Rare cause of adult female incontinence: complete duplication of the collecting system and ectopic ureter of the kidney draining into the vagina treated by laparoscopic upper pole heminephrectomy and ureterectomy

A 38-year-old woman presented with a lifelong history of involuntary urinary leakage. The patient reported that she had been operated for her urinary leakage with the diagnosis of stress incontinence with transobturator tape two times at two different institutions. Preoperative computed tomography scan showed complete duplication of the left kidney with poorly functioning upper pole and a tortuous left dilated ureter running down and opening into the vagina. Laparoscopic left upper pole heminephrectomy and ureterectomy were performed uneventfully. Her incontinence improved immediately after surgery.     

The spectrum of paediatric dermatoses in a university hospital in Cairo,Egypt

Background Epidemiological data on paediatric dermatoses in Egypt are scanty. Objective To study the spectrum of paediatric dermatoses in Cairo. Methods The medical records of children attending the dermatology outpatient clinics of Ain Shams University hospital for the year 2001 were retrieved. Data of 3049 patients were included. Demographic data (age and gender) and diagnoses were extracted, coded and analysed. Results Patients’ attendance peaked in summer (42.57%) and revealed female predominance (1.3 : 1). Infections constituted most of dermatoses (52.87%) and impetigo was most common (12.04%). Hypersensitivity came after (18.6%), and contact dermatitis prevailed (6.03%). Females predominated in most dermatoses. Bacterial infections were the most common in both genders. Age distribution revealed prevalence of bacterial infections in infants and preschool children, parasitic infections in school children and sebaceous gland disorders in adolescents. Parasitic infections prevailed in winter and spring, whereas bacterial infections prevailed in summer and autumn. Most dermatoses peaked in summer except urticaria and chicken pox that peaked in spring. Conclusion Infections outnumbered other paediatric dermatoses parallel to the situation in developing communities. Such diseases are potentially controllable and therefore strategies that target infections may represent a key to an efficient child health care programme.