Two cases of interstitial cystitis complicated with migraine

Two cases of interstitial cystitis complicated with migraine and atopic tendency are reported. In the bladder tissue of the two cases, mast cells were increased and in one case which was observed with immunohistochemical staining, most of the mast cells among muscle layers were chymase-positive mast cells. We considered that the degranulation of mast cells was related with the cause of interstitial cystitis and migraine.     

Two cases of idiopathic retroperitoneal fibrosis effectively treated with steroid therapy

Two cases of idiopathic retroperitoneal fibrosis (IRPF) were reported. The first case, in a 72-year old man, was admitted for hydronephrosis with indistinct origin. Following percutaneous nephrostomy, biopsy of retroperitoneal tissue was performed, and IRPF was diagnosed. The treatment consisted of bilateral ureterolysis, intraabdominal transposition of ureters and oral administration of prednisolone for 3 months. The second case, in a 51-year-old woman, was admitted for the evaluation of severe azotemia. As ovarian carcinoma and its ureteral invasion was suspected, simple hysterectomy and bilateral ovariectomy were performed. Typical histological finding of IRPF was also observed. Oral administration of prednisolone has been continued for two years. Recurrence of IRPF has not been observed in these two cases for over two years.     

Two cases of interstitial cystitis complicated with fibromyalgia syndrome

Two cases of interstitial cystitis complicated with fibromyalgia syndrome are reported. These diseases have some similar points regarding symptoms, treatment methods and neurotransmitters causatively involved. The symptoms are hardly recognized. It is important to have knowledge about the disease of fibromyalgia syndrome.     

First report of idiopathic segmental ureteritis successfully treated by steroid therapy

We report a case of bilateral idiopathic segmental ureteritis in a 52‐year‐old woman. The diagnosis was established by imaging studies (magnetic resonance imaging/computed tomography scan), ureteroscopy and biopsies. The left side improved spontaneously, but the right ureteral stricture persisted after 3 months of ureteral stenting. Administration of prednisolone effectively relieved obstruction on the right side after 4 months. This is the first report of idiopathic segmental ureteritis successfully treated by steroid therapy, without invasive open procedures.     

A case of lymphocytic hypophysitis successfully treated with steroid pulse therapy

Lymphocytic hypophysitis is an autoimmune disorder of the pituitary gland. We report a case of lymphocytic hypophysitis managed by high dose methylprednisolone pulse therapy and review the literature. A 61-year-old woman presented with severe headache. Magnetic resonance imaging (MRI) revealed a contrast enhancing pituitary mass. The patient underwent endonasal-transsphenoidal surgery of the pituitary lesion under the diagnosis of a non-secreting pituitary adenoma. Intraoperative histological findings suggested an inflammatory lesion and we performed subtotal resection of the mass. Histopathological examination confirmed the diagnosis of lymphocytic hypophysitis. Postoperatively, she received methylprednisolone pulse therapy and her severe headache resolved. This case report suggests that methylprednisolone pulse therapy may improve the clinical symptoms of lymphocytic hypophysitis.     

Four cases of intracranial AVM successfully treated by radiation therapy

We have treated three patients with conventional radiotherapy and one with stereotactic radiosurgery and report the follow-up results. Case 1 was of a 63-year-old woman who had a dural AVM in the right cavernous sinus. She was irradiated using 10MV X-rays with a total of 30Gy. Post irradiation angiography showed a complete absence of dural AVM. Case 2 was of a 62-year-old woman who had a dural AVM fed by the left external carotid artery in the right cavernous sinus. Embolization by gelfoam was performed before irradiation. The irradiation was given with a total dose of 30Gy. Post irradiation angiography showed disappearance of the dural AVM. Case 3 was of a 26-year-old woman who had a small AVM (about 20 x 15 x 15mm) in the posterior corpus callosum. An operation was performed but the AVM was not excised completely. We irradiated the residual AVM with a total of 30Gy. The follow-up angiography one year after treatment, showed disappearance of the AVM. She had no neurological deficit two years after the treatment. Case 4 was of a 14-year-old boy who had a small AVM (about 20 x 15 x 10mm) in the left anterior wall of the fourth ventricle. The AVM was located deeply, so an operation was not performed. Radiosurgery was undertaken four months after onset in Buenos Aires. The total dose was 36Gy. The follow-up angiography one year after treatment, showed disappearance of the AVM. He also had no neurological deficit two years after the treatment.(ABSTRACT TRUNCATED AT 250 WORDS)     

Two cases of iatrogenic vertebral arteriovenous fistulas successfully treated by surgery

Cervical vertebral arteriovenous fistulas (AVFs) are very rare. The most frequent cause is trauma including iatrogenesis which result from vertebral artery penetration during central venous catheterization. Some endovascular techniques have been reported for this type of lesion. However, several potential problems exist, such as possibility of recurrence of AVFs and VA occlusion with endovascular treatment. In this article, we review two cases with iatrogenic vertebral AVFs which were successfully treated surgically and report the advantages of surgical treatment.     

狼疮性肾炎94例的治疗总结

目的:探讨中西医结合治疗狼疮性肾炎(IN)的疗效。方法:随机设置中西医组和西医组,分别为94例、84例,两组进行有效率、复发率、副作用的比较。结果:西医组总有效率80.9％,复发率21.4％,副作用发生率77.1％;中西医组总有效率94.6％,复发率4.2％,副作用发生率38.0％,中西医组总有效率高于西医组(P<0.05)。结论:中西医结合治疗在提高疗效,减少复发及减轻副作用均显著优于西医组。     

Two cases of severe sepsis successfully treated with activated protein C

A 64-year-old man and a 52-year-old woman in shock with multiple organ failure and worsening of sepsis related organ failure assessment SOFA scores in the early days of care were treated with recombinant human activated protein C (rhAPC). In the woman sepsis was associated with reversible heart failure, with decreased ejection fraction, biventricular dilatation, and a sharp increase of troponin I, observations that have been linked to a higher rate of multiorgan failure and higher mortality. The man began to improve after 24 hours and the woman after 48 hours of rhAPC treatment, with both continuing to improve after withdrawal of treatment. Severe sepsis remains a therapeutic challenge. Among the many treatments based on the physiopathology of the disease, so far only rhAPC seems to improve outcome and reduce mortality.     

Two cases of facial neurinoma successfully treated with gamma knife radiosurgery

Two cases of facial neurinoma successfully treated with gamma knife radiosurgery are reported. Case 1, a 33-year-old female, developed a right-sided hemifacial spasm about five years ago. Then she suffered gradual progression of right-sided facial palsy, dysgeusia and reduction of lacrimation, but she had no hearing disturbance. T1-weighted MRI with gadolinium DTPA showed a well-circumscribed tumor at the geniculate ganglion extending to the middle cranial fossa. The tumor was treated with gamma knife radiosurgery which reduced its size, but didn't reduce the patient's facial palsy. Case 2, a 36-year-old female, presented with fluctuating facial palsy and sensorineural hearing loss lasting for fourteen years. T1-weighted enhanced MRI showed a well-enhanced tumor at the CP angle extending to the middle cranial fossa. The tumor was treated with gamma knife radiosurgery, which caused central tumor necrosis, but didn't reduce the tumor size. Meanwhile the patient's facial palsy improved. Gamma knife radiosurgery is apparently effective against facial neurinomas without producing serious complications such as complete facial palsy and hearing loss. Our study indicates that gamma knife radiosurgery is a useful therapeutic alternative for facial neurinomas.     

中西医结合治疗148例重症狼疮性肾炎的临床报道

目的：探讨中西医结合方法治疗重症狼疮性肾炎的疗效。方法：将２９０例住院患者随机分成两组,其 中中西医结合治疗组（中西组）１４８例,西医治疗组（西医组）１４２例,分别观察其疗效、副作用。结果：中西组治疗有效 率８５．１％,西医组治疗有效率为７３．２％（Ｐ＜０．０５）;副作用中西组３６．４％,西区组为７３．２％（Ｐ＜０．０５）。结论：中西结 合治疗重病狼疮性肾炎疗效明显优于单纯西医治疗,且副作用少。     

Improvement in steroid and immunosuppressive drug resistant lupus nephritis by intravenous prostaglandin E1 therapy

From January 1986 to December 1988, 8 patients with lupus nephritis did not respond to the administration of two courses of methylprednisolone pulse therapy and cyclophosphamide treatment for 56 days. These cases then received intravenous prostaglandin E1 (PGE1) for 3 weeks. All of them had a good response with decreased proteinuria and azotemia; serum C3 and C4 levels and creatinine clearance also increased. Both OKT4+ and OKT8+ cells increased, and the OKT4/OKT8 ratio was almost normal. The macrophage functions included increased production of interleukin 1 and gamma-interferon. The capacity to synthesize immunoglobulin after pokeweed mitogen stimulation was reduced, the circulating immune complexes lowered, and glomerular IgG deposits decreased in the two class IV follow-up biopsy cases after PGE1 therapy. These clinical improvements after PGE1 therapy are probably related to the modulation of macrophage T-B cell interaction, enhancement of reticuloendothelial system function, and increased glomerular capillary flow.     

Mizoribine, tacrolimus, and corticosteroid combination therapy successfully induces remission in patients with lupus nephritis

Background

Conventional cyclophosphamide-based treatment regimens for lupus nephritis (LN) are still not considered to be optimal. The aim of this study was to evaluate the efficacy and safety of mizoribine, tacrolimus, and corticosteroid combination therapy for LN.

Methods

We retrospectively evaluated a combination treatment of mizoribine and tacrolimus with corticosteroids as induction therapy in eight newly diagnosed systemic lupus erythematosus (SLE) patients with biopsy-proven LN.

Results

All patients were women, and their mean [standard deviation (SD)] age was 48.5 (20) years. All patients (100?%) had positive anti-double-stranded DNA (anti-dsDNA) antibody titers, and four (50.0?%) were nephrotic. Mean (SD) serum creatinine and daily proteinuria levels were 0.72 (0.4) mg/dl (range 0.33–1.55?mg/dl) and 4.56 (2.8) g (range 0.77–8.2?g), respectively. By month 2, significant improvements in the anti-dsDNA antibody titers, levels of proteinuria, serum albumin, and C3, and SLE disease activity index score were observed. By month 6, seven patients (87.5?%) were in complete remission, with normalized levels of both proteinuria and serum creatinine.

Conclusions

This pilot study suggests that mizoribine and tacrolimus treatment with corticosteroids is well tolerated and may prove to be an optimal alternative remission-inducing regimen for LN.     

Abdominal pregnancy diagnosed by ultrasonography and treated successfully by laparotomy: Two cases report

IntroductionAbdominal pregnancy is one of the rare types of ectopic pregnancies that has a high rate of mortality. Its clinical presentation is similar to those of the other types of ectopic pregnancies.Cases presentationwe report two cases of abdominal pregnancies whose the diagnosis was made by ultra-sonography and successfully treated by laparotomy in emergency obstetrical department of Ibn Rochd University Hospital of Casablanca.Clinical discussionthe ultra-sonography based on precise criteria represents the fundamental paraclinical examination in the diagnosis of abdominal pregnancies. The treatment of early form is based on surgery; And despite the advent of laparoscopic surgery, laparotomy retains its indications including forms with hemorrhagic shock.ConclusionDue to the high risk of complications and maternal mortality, abdominal pregnancies should be surgically treated as soon as possible when the diagnosis is confirmed.     

Diffuse alveolar hemorrhage in lupus nephritis complicated by microscopic polyangiitis

Diffuse alveolar hemorrhage (DAH) is a rare but fatal complication in patients with systemic lupus erythematosus (SLE). We describe a case of a 74-year-old woman who presented with DAH as an initial presentation of SLE. She also had microscopic polyangiitis clinically manifesting as crescentic glomerulonephritis and purpura with positive myeloperoxidase (MPO)-antineutrophil cytoplasmic antibodies (ANCA). The patient transiently improved when treated with plasma exchange and methylprednisolone pulse therapy; however, she died of recurrent pulmonary hemorrhage and concurrent cryptococcal pneumonia. This case indicates that MPO-ANCA is associated with severe organ involvement such as pulmonary hemorrhage and crescentic glomerulonephritis in SLE.