Necrotizing fasciitis: strategies for diagnosis and management

Necrotizing fasciitis (NF) is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically. The literature addressed NF contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy. A delay in diagnosis is associated with a grave prognosis and increased mortality. The main goal of the clinician must be to establish the diagnosis and initially treat the patient within the standard of care. This review is planned as a guide for the clinician in making an early diagnosis of NF and initiating effective medical and surgical therapy.     

Fertility of ejaculated and testicular megalohead spermatozoa with intracytoplasmic sperm injection

In this study the fertility and outcome of intracytoplasmic sperm injection (ICSI) using megalohead spermatozoa from the ejaculates and testicles was evaluated. Seventeen males with megalohead and pinhead sperm forms in their ejaculate were studied in 22 cycles. A high number of sperm heads without tails and abundant round spermatid forms were commonly observed. Round-headed spermatozoa were seldom accompanied by these severely abnormal spermatozoa. The majority of megalohead spermatozoa were observed to have multiple tails, were predominant in the sample, and were used for ICSI. Ejaculated megalohead spermatozoa were used for ICSI in 15 cycles, while testicular spermatozoa were used in seven cycles where there were no vital spermatozoa or spermatozoa of low vitality in the ejaculate. The same abnormal morphology was observed in the testicles as in the ejaculated spermatozoa in the same males. Mean (+/- SD) low motility 4.7 +/- 5.6% and sperm count (3.8 +/- 4.19 x 10(6)) were common findings in these severely teratozoospermic patients. A low fertilization rate (43.2%) was achieved by using megalohead sperm forms (group I, n = 17) in comparison with the control group (60.2%) which had zero normal sperm morphology according to strict criteria (group II, n = 30) (P <0.01). Furthermore, a low pregnancy rate (9.1%) was obtained in the megalohead sperm group in comparison with the control group (40%) (P <0.05). Low fertilization and pregnancy rates may be due to a high incidence of chromosomal abnormalities from severely defective spermatozoa in the ejaculate. Couples should be counselled and warned about possible low fertilization and pregnancy rates with ICSI when only pinhead and megalohead forms with a high number of sperm heads without tails are present in the ejaculate.     

Hepatomesenteric trunk

Abstract An hepatomesenteric trunk, formed by the common hepatic and superior mesenteric arteries, was found in a 50-year-old male cadaver. The left gastric and splenic arteries arose as a common trunk, the gastrosplenic trunk, from the abdominal aorta; no typical celiac trunk was present. In addition, the hepatomesenteric trunk passed posterior to the portal vein. A knowledge of variations of the common hepatic artery may be important in pancreaticoduodenectomy, as well as during hepatic artery infusion chemotherapy.     

Benign leiomyoma with multiple metastases to vertebrae and calvarium: An index case with comprehensive review of endocrine targets

Neurosurgical Review - “Benign” metastatic leiomyomas (BML) are indolently growing metastatic tumors which mostly associate with uterine leiomyomas in women in reproductive ages. The...     

Acceptable age for prophylactic surgery in children with multiple endocrine neoplasia type 2a.

AIMS: Germline mutated RET proto-oncogene, causing multiple endocrine neoplasia (MEN)-2a syndrome is the indication for prophylactic total thyroidectomy. Literature regarding the risk and the extent of early surgical intervention is scarce and the optimum age for surgery is still controversial. To optimize management in these young children we evaluate our experience and results. PATIENTS AND METHODS: From 1990 to 2001 preventive total thyroidectomy was performed in 13 MEN-2a gene carriers (4 boys and 9 girls; median age 7 (4-14) years). Preoperative assessment, surgical procedure, pathological examination, postoperative complications and treatment results were studied. RESULTS:Surgery existed of a total thyroidectomy alone (n=3) in children with normal basal calcitonin and in combination with tracheo-esophageal exploration (n=6) or central compartment dissection (n=4) in case of abnormal calcitonin levels. Eight children presented with medullary thyroid cancer (MTC), three (median: 5 (4-12) years) with microscopic MTC and five (median 6 (4-14) years) with frank invasive MTC. Four of these five patients were younger than 6 years. Except for long-lasting hypoparathyroidism in one patient there were no complications. At a median follow-up of 6.5 years all patients are disease free. CONCLUSION: MTC in RET mutated MEN-2a gene carriers in childhood are found at the age of 4 years. Therefore, DNA testing should be done preferably before that age. Preventive surgery can be performed safely at that age and may be limited to total thyroidectomy when baseline calcitonin levels are normal.     

Is Transforming Stem Cells to Pancreatic Beta Cells Still the Holy Grail for Type 2 Diabetes?

Diabetes is a progressive disease affecting millions of people worldwide. There are several medications and treatment options to improve the life quality of people with diabetes. One of the strategies for the treatment of diabetes could be the use of human pluripotent stem cells or induced pluripotent stem cells. The recent advances in differentiation of stem cells into insulin-secreting beta-like cells in vitro make the transplantation of the stem cell-derived beta-like cells an attractive approach for treatment of type 1 and type 2 diabetes. While stem cell-derived beta-like cells provide an unlimited cell source for beta cell replacement therapies, these cells can also be used as a platform for drug screening or modeling diseases.     

Previous Mental Illness Diagnoses Predict Perceptions of Current Mental Illness: A Cultural and Gender Differences Analysis of the United States and India

The disparities in mental health care around the world have led to differences in the way mental illness is treated, diagnosed, and stigmatized. The studies conducted revealed in this article investigated differences between the United States and India in terms of their willingness to agree with a possible mental illness diagnosis. Each study was conducted online using FluidSurveys®. Participants were recruited via Amazon’s® Mechanical Turk® (MTurk), which is a website that provides access to an online, highly diverse participant pool. For Study 1, we hypothesized that there would be significant differences in agreement rates between the two countries and that there would be a positive relationship between agreement rates and the number of previous diagnoses. The three main hypotheses for Study 2 were that there would be a significant difference in agreement rates for the United States and India, the gender of the target individual would have a main effect, and the gender of the participant would have a main effect. The first study was focused on how the number of previous diagnoses would affect agreement rates and how that effect differed between the two countries. The second study looked specifically at how the gender of the participant as well as the gender of the target individual would affect agreement rates. Study 1 yielded significant differences between the United States and India for agreement rates when no previous diagnosis was presented. There was also evidence that as the number of previous diagnoses went from zero, to three, to five, agreement rates also increased. Study 2 also yielded significant differences between the two countries. There was a main effect of participant gender on agreement rates, but no main effect found for target gender.