Maternal exposure to diethylene glycol monomethyl ether: a possible role in the etiology of retrocaval ureter

Retrocaval ureter is a very rare condition. In light of the experimental studies, one of the etiologic factors seems to be maternal contact with diethylene glycol monomethyl ether or ethylene glycol monomethyl ether. A case of cardiovascular, skeletal, and retrocaval ureter anomalies caused by possible maternal contact while pregnant with these materials at her work in a textile factory is presented. J Pediatr Surg 37:E23.     

A case of coumarin necrosis with penile and pedal involvement

A 57-year-old male patient with advanced adenocarcinoma of the lung, who was administered oral anticoagulant therapy because of pulmonary embolism, developed coumarin necrosis confined to the penis and feet. To our knowledge, this patient showing acral involvement is the seventh case of coumarin-induced penile necrosis reported to date.     

Are Repeat Biopsies Required in Men with PSA Levels ≤4 ng/ml? A Multiinstitutional Prospective European Study

OBJECTIVES: Pathological and biochemical features of prostate cancers detected on repeat biopsies in men with total PSA level between 2.0 and 4 ng/ml were evaluated and compared to those cancers detected on first biopsy. METHODS: 315 men with PSA level between 2.0 and 4 ng/ml underwent transrectal ultrasound guided sextant biopsy and two additional transition zone biopsies (Octant Biopsy). All subjects whose biopsy samples were negative for prostate cancer underwent a repeat biopsy after 6 weeks. Those with clinically localized cancers were offered surgery or radiation therapy. Pathological and clinical features of patients diagnosed with prostate cancer on initial and repeat biopsy were compared. RESULTS: Cancer detection rates on first and second biopsy were 24% (75/315) and 13% (29/224), respectively. Overall, of patients with clinically localized disease (83% of cancers detected), 87% underwent radical prostatectomy, 11% opted for radiation therapy and 2% opted for watchful waiting. Cancers found in the first biopsy group were more multifocal (p = 0.01) while cancers found on second biopsy were more located in the apical-dorsal region (p = 0.003). No significant differences were noted with respect to extracapsular extension, seminal vesical invasion, positive margins, final pathological stage, Gleason score, percentage Gleason grade 4/5, serum PSA and patient age between first and second biopsy. CONCLUSIONS: With an octant biopsy regime, biochemical and pathological features of cancers detected on initial and repeat biopsy in the PSA range 2.0 to 4 ng/ml are comparable in terms of PSA, grade, stage and cancer volume suggesting identical cancer characteristics, thus advocating for a repeat prostate biopsy in case of a negative finding on initial biopsy.     

The roles of HRCT and clinical parameters in assessing activity of suspected smear negative pulmonary tuberculosis

BACKGROUND: Smear-negative pulmonary tuberculosis (SNPTB) constitutes a major problem in countries with a moderate or high TB prevalence. The value of high-resolution computed tomography (HRCT), chest x-ray and other clinical findings in determining activity of SNPTB were investigated. METHODS: The study population consisted of 85 patients with suspected SNPTB, of whom 52 were confirmed as active pulmonary TB according to either culture positivity for Mycobacteriun tuberculosis or demonstration of caseous granulomatous inflammation. The remaining 33 patients accepted inactive TB sequel. RESULTS: Cough and expectoration were significantly frequent in inactive group whereas chest pain was detected higher in active patients. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of HRCT in detecting disease activity were 88, 88, 92, 83 and 88%, respectively. Centrilobular nodules, other non-calcified nodules, consolidation and cavity were significantly higher on HRCT in active group. Chest x-ray scores that were graded 1 to 3 showed a linear trend for the disease activity. CONCLUSIONS: HRCT has good diagnostic value in detecting activity of SNPTB, and some clinical findings may help in predicting the activity.     

Anatomical dimensions of anterior bundle of ulnar collateral ligament and its role in elbow stability

OBJECTIVE: To study the anatomical dimensions of the anterior bundle of ulnar collateral ligament and its role in elbow instability. METHODS: We studied 20 elbows of 10 cadavers. Anterior bundle of ulnar collateral ligament was dissected in all elbows and its anatomical length and width were measured. After measuring it, we assessed the role of the anterior bundle of ulnar collateral ligament in the medial elbow joint stability, with the capsule, the radial head and anterior bundle of ulnar collateral ligament being cut. RESULTS: The mean right length of the anterior bundle of ulnar collateral ligament was 21.10 +/- 6.29 mm and the mean left length was 21.70 +/- 5.31 mm. The mean right width of the anterior bundle of ulnar collateral ligament was 12.70 +/- 2.79 mm and the mean left width was 13.90 +/- 2.37 mm. Anterior bundle of ulnar collateral ligament was found to be the main stabilizer of the valgus stress. The anterior capsule and the radial head also make contributions to this stability. However, when anterior bundle of ulnar collateral ligament is cut, the radial head and the anterior capsule fails to maintain the stability against valgus stress. CONCLUSIONS: The anatomical dimensions of the anterior bundle of ulnar collateral ligament are important for a surgeon when graft is used in reconstructing this ligament. Our study is an initiator of this topic and we believe that with larger series, more reliable anatomical measurements can be obtained. We also showed that the anterior bundle of ulnar collateral ligament is the main medial stabilizer of the elbow joint.     

End-to-side nerve coaptation: is an additional proximal coaptation useful when available?

The aim of this experimental study was to evaluate the effects of end-to-side coaptation of the proximal end of a severed nerve to the same intact nerve, in addition to traditional end-to-side coaptation of the distal end, with an aim to use the intact nerve as a nerve conduit in a rat model and to compare the functional and histologic results of this modality to those obtained after nerve grafting and traditional end-to-side nerve coaptation. In group A, a peroneal nerve defect measuring 1 cm was created in the left hind limb, and a nerve graft 1 cm long was used to bridge the defect. In group B, only the distal stump of the peroneal nerve was coapted to the intact tibial nerve. In group C, both ends of the peroneal nerve defect were coapted to the intact tibial nerve in an end-to-side fashion 1.5 cm apart from each other, and in group D, the peroneal nerve defect was left unrepaired. Group E was consisted of nonoperated peroneal nerves that were used to obtain normative data. Although significantly higher myelinated axon densities were observed in groups B and C compared with group A and group E, total number of the myelinated axons was significantly higher only in group C. Peroneal functional index assessments demonstrated that nerve recovery in the peroneal nerve was similar in groups A and C, and both were better than those observed in groups B and D. Collectively, these results suggest that end-to-side coaptation of both ends of a severed nerve to an intact nerve, in case of a nerve defect in this length, may serve as an alternative for nerve grafting.     

Development of calciphylaxis after long-term steroid and methotroxate use in a patient with rheumatoid arthritis

Calciphylaxis may be considered a small vessel vasculopathy which is generaly associated with end-stage renal disease and hyperparathyroidism. The precise pathogenesis of the disease is not known. It needs sensitizers and challengers to occur. Steroids and immunosuppressive drugs including methotrexate are among those challenger agents. Calciphylaxis in collagen vascular diseases is rare. Only one case in rheumatoid arthritis was recently reported. Here we describe a case of calciphylaxis associated with active rheumatoid arthritis. This patient had active disease despite treatment of steroids and methotrexate for a long time. She died shortly after the diagnosis of calciphylaxis due to sepsis.     

Surgical importance of highly located innominate artery in neck surgery

Massive hemorrhage is an unusual complication of tracheotomy, and the most common causes are injury to the anterior jugular veins and the thyroid isthmus, or unrecognized variations of the vascular structures, such as the arteria thyroidea ima. We present a case of high-running innominate artery that ascends until the third tracheal ring and courses horizontally anterior to the trachea in a patient with laryngeal carcinoma. If not noticed during tracheolaryngeal surgery, trauma to this vessel and subsequent hemorrhage may be fatal. In this report, the case is presented and the surgical significance of this anomaly is emphasized.