Acute Korsakoff syndrome following mammillothalamic tract infarction

There are limited case reports of structural lesions causing Korsakoff syndrome. This report describes acute Korsakoff syndrome following localized, bilateral infarction of the mammillothalamic tracts (MTTs). Axial T2-weighted imaging revealed the lesions at the lateral wall level of the third ventricle and diffusion-weighted imaging confirmed that the left lesion was new and the right old. Korsakoff syndrome persisted 6 months after the onset. This case suggests that bilateral MTT dysfunction can lead to Korsakoff syndrome.     

Conventional open surgery versus percutaneous catheter drainage in the treatment of cervical necrotizing fasciitis and descending necrotizing mediastinitis

OBJECTIVE: The purpose of our study was to determine the clinical usefulness of percutaneous catheter drainage compared with conventional surgical drainage for cervical necrotizing fasciitis and descending necrotizing mediastinitis. SUBJECTS AND METHODS. Thirty-one patients with cervical necrotizing fasciitis and descending necrotizing mediastinitis were included. Twenty consecutive patients were treated by percutaneous catheter drainage. Catheters were introduced into the infected space from the neck, under the guidance of sonography and X-ray fluoroscopy. The results of the treatment were compared with those of 11 patients treated previously by surgical drainage. RESULTS: In the catheter group, no patient required supplementary surgical drainage. Mortality was 0% in both groups. Comparison of length of stay in the ICU, serial changes in C-reactive protein levels, duration of antibiotic therapy, and duration of mechanical ventilation all showed no statistically significant difference between groups. Secondary infection of the wound and positive culture of antibiotic-resistant bacteria were observed less frequently in the catheter group than in the open surgical group. The total use of plasma infusion and analgesics was significantly less in the catheter group than in the surgery group. Oral feeding was started significantly earlier in the catheter group than in the surgery group. CONCLUSION: Percutaneous catheter drainage for cervical necrotizing fasciitis and descending necrotizing mediastinitis was less invasive than conventional surgical drainage but produced a similar outcome.     

Pulmonary dirofilariasis: computed tomography findings and correlation with pathologic features

OBJECTIVE: The purpose of this study was to describe the computed tomography (CT) and pathologic features of 5 nodules of pulmonary dirofilariasis in 4 patients. METHODS: Four patients with 5 nodules of pathologically confirmed pulmonary dirofilariasis who under went CT were enrolled, and the imaging interpretations were retrospectively compared with the histopathologic characteristics. RESULTS: Three of the 4 patients had a solitary nodule, and the remaining patient had 2 nodules. All the nodules were distributed in the right lower lobe and were attached to the pleura. They were all round or oval in shape and ranged in size from 11 to 22 mm in largest diameter (mean=17 mm). On thinner section CT, the nodules had a well-defined smooth margin with or without a shallow notch; they were connected to the arterial branch and, occasionally, to the venous branch. On contrast-enhanced CT, all the nodules contained a homogeneous low-attenuation area, which corresponded to areas of coagulative necrosis on histopathologic examination. CONCLUSION: Although the CT findings of a pulmonary dirofilariasis nodule are nonspecific, awareness of the findings on contrast-enhanced CT and the pathologic appearance of this rare benign condition may facilitate its differentiation from a malignant nodule.     

Endovascular stent graft for management of ureteroarterial fistula: a case report

We report a case of ureteral-iliac artery fistula and its minimally invasive management with endovascular stent grafting. A 76-year-old male was admitted with massive gross hematuria from an ilial conduit. He underwent a radical cystectomy with ileal loop urinary diversion for bladder cancer 7 months ago and had undergone placement of a 7 Fr single-J ureteral catheter for repair of a partial disruption of the left ureteroileal anastomosis. Although the fistula was not confirmed radiographically, a left ureteral-common iliac artery fistula was highly suspected. The patient was treated by percutaneous placement of an autoexpandable covered stent graft across the left common iliac and left external iliac artery. After successful endovascular management of the ureteroarterial fistula, the patient's hematuria resolved and he recovered fully. During 10 months of follow up, he has been free of hemorrhagic episodes. Because open surgical repair may be difficult and associated with significant risk for complications, endovascular intervention may provide a safety treatment alternative.     

Surgery for acute aortic dissection concomitant with preceding axillofemoral bypass to prevent malperfusion of visceral organs and limb ischemia

A 52-year-old man was admitted with sudden onset of epigastralgia. Abdominal X-ray showed dilated intestine and computed tomography (CT) revealed extended type A aortic dissection. Marked abdominal distention and weak pulse of right femoral artery were recognized so malperfusion of visceral organs due to narrowing true lumen compressed by thrombosed false lumen was suggested. In the operation, right axillo-right femoral bypass was established preceding to median sternotomy. This graft was used as an arterial perfusion site of cardiopulmonary bypass, and replacement of the ascending aorta was performed under hypothermic circulatory arrest and retrograde cerebral perfusion. Sign of malperfusion of visceral organs was showed for several days after the operation but it disappeared without further intervention. Axillofemoral inflow of cardiopulmonary bypass may be effective procedure in these cases.     

The oblique posterior femoral condylar radiographic view following total knee arthroplasty

BACKGROUND: It is often difficult to evaluate the posterior aspects of the femoral condyles after total knee arthroplasty. We have developed an imaging technique involving the use of the oblique posterior condylar view for the evaluation of the posterior aspects of the femoral condyles. The purpose of the present study was to compare the efficacy of this view with that of the true-lateral view. METHODS: Three orthopaedic surgeons analyzed fifty-five sets of radiographs (consisting of oblique posterior condylar and true-lateral views) for patients who had undergone total knee arthroplasty. The accuracy and reproducibility of the oblique posterior condylar view for the detection of radiolucencies were compared with those of the true-lateral view. RESULTS: The oblique posterior condylar view was significantly better than the true-lateral view for the detection of radiolucencies of the posterior aspects of the femoral condyles (p < 0.0005). CONCLUSIONS: Radiographic analysis with use of the oblique posterior condylar view is technically easy and is accurate for the evaluation of radiolucencies of the posterior aspects of the femoral condyles after total knee arthroplasty.     

Induction of the DNA repair gene O6-methylguanine-DNA methyltransferase by dexamethasone in glioblastomas

OBJECT: The DNA repair enzyme O6-methylguanine-DNA methyltransferase (MGMT) inhibits the cytotoxic effect of alkylating agents on tumor cells. The presence of two nonconsensus glucocorticoid-responsive elements in the human MGMT promoter region indicates the potential regulation of MGMT expression by glucocorticoid agents. This study was performed to elucidate whether dexamethasone affects the expression of MGMT in glioblastoma multiforme (GBM) cells, thereby limiting the benefit of chemotherapeutic alkylating agents. METHODS: Four GBM cell lines (A172, T98G, U138MG, and U87MG) were exposed to the alkylating agent 1-(4-amino-2-methyl-5-pyrimidinyl) methyl-3-(2-chloroethyl)-3-nitrosourea hydrochloride (ACNU) with or without dexamethasone. The expression levels of MGMT were correlated with the cytotoxic effects of ACNU in GBM cells. In the presence of ACNU alone, dexamethasone alone, and the combination of both agents, messenger RNA expression of MGMT was induced to varying degrees with the highest increases seen in the later conditions. This dexamethasone-dependent induction of the MGMT gene was even observed in U87MG cells in which the promoter is methylated, although the absolute expression of MGMT mRNA was the lowest in that cell line. The induction of MGMT by dexamethasone was associated with an increased resistance of these cells to ACNU. CONCLUSIONS: These results indicate that dexamethasone-mediated upregulation of MGMT limits the efficiency of alkylating agents in the treatment of malignant gliomas.     

Prevention of hepatitis B virus recurrence after living donor liver transplantation

The emergence of lamivudine-resistant hepatitis B mutations is a major complication during pretransplantation treatment. The proper time to begin Lamivudine before transplantation is not yet known. Twenty-six patients received preoperative lamivudine treatment followed by combined lamivudine and hepatitis B immunoglobulin after transplantation up to December 2002. The length of preoperative lamivudine treatment ranged from 13 to 200 days (mean, 52 +/- 37 days). Hepatitis B virus-DNA was positive in 22 of 26 (84.6%) patients before preoperative lamivudine prophylaxis and persistently positive among only 4 of 22 patients (18%) who at transplantation did not show a viral mutation. In all patients, hepatitis B virus-DNA became negative immediately after transplantation. At a median follow-up of 34 months, neither a hepatitis B recurrence nor a mutation had occurred in any patient. The ability to schedule the proper time for preoperative lamivudine prophylaxis is an advantage of living donor liver transplantation.