Severe acute renal failure after massive attack of Africanized bees

Sir, Acute renal failure (ARF) is a rare complication of massiveattack by Africanized bees and can be observed 48–72 hafter the accident [1]. There are nearly 30 cases reported inthe literature [2,3]. We report the case of a massive attackof     

Combined use of plasmapheresis and antidigoxin antibodies in a patient with severe digoxin intoxication and acute renal failure.

Digitalis intoxication is a common and potentially life-threateningsituation [1]. In this condition, the administration of digoxin-specificantibodies (Fab) have proven to be effective in controllingserious complications [2]. However, in patients with severerenal impairment, the clearance of Fab–digoxin complexesis     

Cardiovascular abnormalities in patients with epilepsy receiving renal replacement therapy with dialysis: a true convergence of clinical cardiology, nephrology and neurology.

Sir, We read with great interest a very comprehensive review articleentitled ‘Kidney disease in cardiology’ by ProfessorCharles Herzog [1] published in the January issue of NephrologyDialysis Transplantation. Epilepsy is the most common serious neurological condition.Approximately 50 million people worldwide have epilepsy [2].In the United States each year, 100 000 new cases of epilepsyare diagnosed [3,4]. In the UK between 1 in 140 and 1 in 200people     

Unique presentation and management of Gowers intrasyringal hemorrhage

Context: Intrasyringal hemorrhage was first described in literature in the renowned Lectures on Diseases of the Nervous System by Sir William Richard Gowers [Gowers W. A lecture on syringal haemorrhage into the spinal cord. Lancet [Internet]; 162(4180):993–997. [cited 2019 August 19]. Available from https://www.sciencedirect.com/science/article/pii/S0140673601362785]. The pathophysiology of this disease is a hemorrhage within a preexisting intramedullary fluid-filled cavity or hydrosyringomyelia in the spinal cord. Most common symptoms of this disease are numbness, weakness, paresthesia in the extremities and gait disturbances. Since first noted in 1903, there have been just fourteen confirmed cases of this disease reported in literature, making it extremely rare and difficult to study.Findings: Here we discuss a unique presentation of Gowers intrasyringal hemorrhage. The patient is a male in his late teens with no prior established neurological history. He presented at our institution four days post suspected injury with persistent mild left upper extremity numbness and weakness. The patient was admitted and underwent an MRI of the cervical spine without intravenous contrast. The imaging findings confirm subacute on chronic Gowers intrasyringal hemorrhage in the setting of a Chiari 1 malformation. This patient underwent neurosurgical intervention four months post initial presentation and had complete postoperative resolution of his interval non-progressive but persistent symptoms.Clinical relevance: This unique case suggests immediate surgical intervention may not always be necessary for treating Gowers intrasyringal hemorrhage.     

Anatomy and management of the foot in Apert syndrome: A review of the literature

BackgroundApert syndrome (acrocephalosyndactyly type 1) is a complex condition characterised by craniosynostosis and syndactyly of the hand and feet [Holten IW, Smith AW, Bourne AJ, David DJ. The Apert syndrome hand: pathalogic anatomy and clinical manifestations. Plast Reconstruct Surg 1997;99:1681–97]. The effect of Apert syndrome on the feet has received little attention in the literature when compared to upper limb abnormalities. Early treatment and advances in the care of other aspects of Apert syndrome (for example craniofacial and ophthalmologic abnormalities) has meant individuals with Apert syndrome may now have increased life expectancy and quality of life, and hence place increased demands on their feet.ObjectiveTo review the most recent literature pertaining to the feet in Apert syndrome and to present the findings along with suggestions for conservative and surgical management supported by the literature.MethodA search of the CINAHL, OVID and MEDLINE databases in addition to the NHS Education for Scotland e-Library Journal database was performed using “Apert” and “Foot” as keywords. The reference lists from the literature produced from those searches were scrutinised. A hand search of other journals (Journal of the American Podiatric Medical Association, American Journal of Medical Genetics, Clinics in Plastic Surgery) was also performed.ResultsThe main features of the Apert foot are syndactyly, progressive osseous fusions, rigidity, and difficulty with shoe fitting as a result of an abnormally broad great toe. These alterations in foot mechanics cause increased stress on the soft tissues of the foot causing painful calluses and recurrent nail sepsis.ConclusionsFoot pathology in the Apert foot varies greatly, and a multi disciplinary approach to care is to be commended. Radiography ought to be performed to establish the skeletal nature of the Apert foot even if clinical examination suggests typical Apert feet [Anderson PJ, Smith PJ, Jones BM, Hayward RD. Additional metatarsal bones in Apert's syndrome. Foot 1996;6:37–8]. Conservative measures (footwear/orthotic provision, callous debridement) may be used to alleviate pain around areas of high pressure. The decision to operate will most likely be taken in terms of functional rather than cosmetic improvement, although syndactyly release may be psychologically beneficial in terms of social normalisation.     

Renal agenesis, ureteral ectopia into seminal vesicle, vas deferens agenesis and hemivertebra: An incomplete form of caudal regression syndrome?

The association of seminal vesicle cyst and upper urinary tract malformation is well known in the literature [1]. More rarely, urogenital malformations are associated with vertebral [2] or anorectal anomalies [3]. A 35-year-old infertile man with unilateral renal and deferential agenesis, seminal vesicle cyst and hemivertebra is reported. This complex malformative syndrome has been reported previously by Sheih et al. [4] and, to our knowledge, this is the third case described in the literature.     

Ethnic Difference in Contribution of Sp1 Site Variation of COLIA1 Gene in Genetic Predisposition to Osteoporosis

Osteoporosis, a condition characterized by low bone mineral density (BMD) leading to bone fragility [1], is a major public health concern in Japan as well as in other countries. Although genetic predisposition seems to be a factor in the pathogenesis of osteoporosis [2–4], the precise cohort of genes that may be involved is not well defined. The COLIA1 and COLIA2 genes encode polypeptide constituents of collagen type Iα1 and Iα2, respectively. Both are important candidates as genetic regulators of BMD, since mutations in either gene result in osteogenesis imperfecta, a disorder characterized by severe osteoporosis [5]. Some patients with adult osteoporosis also carry mutations in COLIA1 or COLIA2 genes [6]. Received: 8 December 1998 / Accepted: 23 April 1999     

Foreign-body aspiration during microlaryngoscopy: an unusual case of instrument failure

Instrument failure leading to patient morbidity is a recognized surgical complication that has been reported most commonly in the orthopedic and obstetrical literature [Small NC. Complications in arthroscopy performed by experienced arthroscopists. Arthroscopy 1989;4:215-221; Price MV, Molloy S, Solan MC, Sutton A, Ricketts DM. The rate of instrument breakage during orthopaedic procedures. Int Orthop 2002;26(3):185-7; In Y, Bahk WJ, Park JB. Detachment of the tip of a motorized shaver within the knee joint: a complication of arthroscopic surgery. Arthroscopy 2003;19(6):E29-31; Ostrzenski A. An intraoperative method of localizing a missing piece of a broken laparoscopic instrument. Am J Obstet Gynecol 1997;176:726-7]. Instrument failure resulting in airway foreign bodies, to our knowledge, has been reported only once in the English medical literature [Roach JM, Ripple G, Dillard TA. Inadvertent loss of bronchoscopy instruments in the tracheobronchial tree. Chest 1992;101(2):568-9]. This case report describes the aspiration of a fractured portion of a microlaryngeal instrument caused by metal fatigue and corrosion. The authors recommend vigilant and routine inspection of microlaryngeal instruments for early detection of metal corrosion and fatigue.     

Granuloma Faciale Successfully Treated With Long-Pulsed Tunable Dye Laser

BACKGROUND: Granuloma faciale has been treated in the past with different modalities but the majority have had the risk of scarring. OBJECTIVE: Based on the principle of selective photothermolysis, we considered using the newer long-pulsed tunable dye laser for the treatment of granuloma faciale to target the vessels and minimize scarring. METHODS: Confirmation of the diagnosis by a punch biopsy of the lesion was followed by three treatments on separate occasions 6 weeks apart with the long-pulsed tunable dye laser. RESULTS: There was significant flattening of the lesions after two treatments, with complete clearing after the third. No scarring was detectable and there was no recurrence in the 9-month follow-up. CONCLUSION: We conclude that granuloma faciale may be successfully treated with the long-pulsed tunable dye laser with minimal risk of scarring, especially in cosmetically sensitive areas.     

Bilateral calcaneal fracture in childhood

Calcaneal fractures in young children are rare. Bilateral calcaneal fractures in this age group are exceptional. In the literature only 4 cases of bilateral calcaneal fractures have been reported, and the youngest patient was 6 years old (range 6–17 years) [2, 8]. Jonasch [4] estimated that calcaneal fractures accounted for 0.005% of all fractures before the age of 15, in contrast to 1%–2% in adults. This is confirmed by other studies [5, 8, 10]. It is not unlikely that the incidence is indeed higher because the joint involvement in childhood injuries is often subtle, and the fracture can easily be overlooked on initial X-ray examination [7, 8]. We survey the literature and report the case of a 5-year-old boy who sustained bilateral calcaneal fractures and an additional fracture of the neck of the talus on one side, a combination which to our knowledge has never been described before. Received: 24 March 1997     

An unusual cause of nasal airway obstruction: eosinophilic angiocentric fibrosis

Eosinophilic angiocentric fibrosis is a rare disease of unknown cause. This disease, which involves the upper respiratory mucosa, resembles another rare entity, granuloma faciale. Allergy is thought to be an etiological factor and complete surgical excision is the preferred treatment. A case of eosinophilic angiocentric fibrosis of the nasal septum causing airway obstruction is presented here. This is the sixth case to be reported in the English literature, with well-documented histopathological confirmation. Received: 25 May 1999 / Accepted: 23 June 1999     

A rare case of spinal injury: bilateral facet dislocation without fracture at the lumbosacral joint

Lumbosacral dislocations are rare disorders; since they were first reported by Watson-Jones [1], only 100 cases have appeared in the literature [2]. A traumatic bilateral lumbosacral dislocation is even rarer, with a mere 10 cases reported [3]. Because of its low incidence and atypical location, the lesion may often go unnoticed on initial clinical assessment [4]. Surgical treatment modalities are not defined, but open reduction and internal fixation are often necessary because of a three-column involvement [5]. In this paper, we report on an initially misdiagnosed case of lumbosacral dislocation treated with open reduction and internal fixation.     

Acute reversible renal failure in acute generalized exanthematous pustulosis.

Sir, Acute generalized exanthematous pustulosis (AGEP) is characterizedby rapidly evolving, generalized, aseptic non-follicular pustulareruption arising on a widespread oedematous erythema [1,2].AGEP was introduced to the international literature as distinctclinical entity only in 1980 [3] and it is in >80% of allcases considered to be a special subtype of cutaneous adversedrug reaction [1,2]. Reduced renal function has been describedpreviously in about a     

Appendicitis and low-flow priapism in children

Priapism is a sustained erection that is maintained for over 4 hours in the absence of sexual stimulation [Postgrad Med J. 2006;82(964):89-94; J Urol. 2003;170:1318-1324]. Distinction is made between low- and high-flow variants [J Urol. 2003;170:1318-1324; Cardiovasc Intervent Radiol. 2002;25(4):326-329]. Low-flow priapism (LFP) and acute appendicitis are rarely associated. Including ours, there are 4 cases reported in the literature, all of which have occurred in children. The complications of LFP are potentially serious and include loss of the phallus altogether. Treatment of LFP is should be prompt and is the same irrespective of the etiology.