Intracranial abscesses associated with chronic suppurative otitis media

Intracranial abscesses are serious complications of chronic suppurative otitis media (COM). This study included 32 patients presenting with intracranial abscesses from 780 patients hospitalized for treatment of COM. The 32 patients had 59 intracranial complications. Perisinus abscess (13 of 32) was the most common intracranial abscess, followed by temporal lobe abscess (8 of 32), epidural abscess (7 of 32), cerebellar abscess (6 of 32) and subdural empyema (2 of 32). Headache (93%), fever (87%) and altered mental status (62%) were the most common presenting symptoms and signs, along with symptoms of COM. All patients were treated with intravenous antibiotics and canal wall down mastoidectomy. Cholesteatoma with granulation tissue and bony defects at the sinus plate and/or dural plate were seen in most of the patients. Gram negative bacilli and anaerobes were the most common organisms cultured from the abscesses. Three patients had neurological sequels. One patient died. The early diagnosis of these complications requires a high index of suspicion and imaging studies. A multidisciplinary and coordinated approach is important for the management of these patients.The authors did not receive any financial support for the present study.     

Mud bath dermatitis due to cinnamon oil

A case of long-lasting, extensive eczematous and bullous dermatitis affecting exposed areas (arms and legs), beginning within 24 hr after having a mud bath with cinnamon essential oil in a spa, in a 74-year-old woman, is reported. Patch tests with the GEIDC standard battery and the dental battery (including clove essence and eugenol), cinnamon essence and its components were carried out 5 years later. Fragrance mix, cinnamon essence, eugenol, cinnamic alcohol and cinnamic aldehyde yielded a positive result. To our knowledge, this is the first case of cinnamon dermatitis after a mud bath.     

FDG PET CT assessment of treatment response after yttrium-90 ibritumomab tiuxetan radioimmunotherapy

Yttrium-90 ibritumomab tiuxetan (Zevalin; IDEC Pharmaceuticals Corp., San Diego, CA) is the first radioimmunotherapy agent approved by the U.S. Food and Drug Administration (FDA) for treatment of non-Hodgkin lymphoma. In a randomized clinical trial comparing Zevalin with rituximab, the overall response rate was 80% and 56%, respectively. Response was determined by assessing the size of lymph nodes on CT scans. FDG PET has been well accepted as an accurate imaging study for staging non-Hodgkin lymphoma and evaluating response to treatment. Simultaneous FDG PET and CT imaging (PET CT) provides coregistered functional PET images with anatomic CT images. We describe 2 cases of non-Hodgkin lymphoma treated in which response was followed using PET CT.     

Nitric oxide-dependent mitotic activity in salivary glands of the rat upon sympathetic stimulation

Incorporation of [3H]thymidine into trichloroacetic acid (TCA)-insoluble material of the parotid and submandibular glands was used as an index of mitotic activity following unilateral electrical stimulation of the sympathetic innervation (20 Hz, 4 min every fifth minute over 34 min). Stimulation under beta-adrenoceptor blockade (propranolol 2 mg/kg, intravenous) alone or combined with alpha-adrenoceptor blockade (phentolamine 2 mg/kg, intravenous) did not increase the rate of [3H]thymidine incorporation into the two types of glands. However, under alpha-adrenoceptor blockade the [3H]thymidine incorporation increased into the parotid glands, by 122% (compared to the glands on the contralateral side), but not into the submandibular glands. In the presence of the neuronal type NO-synthase (nNOS) blocker N-PLA (30 mg/kg, intravenous) or the unselective NO-synthase blocker L-NAME (30 mg/kg, intravenous), this increase was reduced to 49 and 47%, respectively. Thus, the major part of the sympathetically nerve-evoked beta-adrenoceptor-mediated mitotic response was found to depend on the activity of neuronal type NO-synthase to generate NO. Since the sympathetic nerve fibres of the parotid gland lack NO-synthase, the neuronal type NO-synthase subjected to the inhibitors is likely to be of parenchymal origin.     

Immunohistochemical detection of 1,25-dihydroxyvitamin D receptor in rat vaginal epithelium

OBJECTIVE: To determine the distribution of 1,25-dihydroxyvitamin D receptor (VDR) in rat vaginal epithelium during the estrus cycle and in ovariectomized rats. DESIGN: Animal study performed in two groups of rats. The expression of VDR was examined in the first group during the estrous cycle and in the second group after ovariectomy. SETTING: University animal laboratory. ANIMAL(S): Balb/c female rats. INTERVENTION(S): Vaginas were removed and processed for immunohistochemical analysis. MAIN OUTCOME MEASURE(S): We recorded the localization, distribution, and expression of VDR in vaginal epithelium during the rat estrus cycle and in ovariectomized rats. RESULT(S): In cyclic rats, VDR was detected in basal and suprabasal cells during all of the cycle periods. In apical cells, VDR was positive in diestrus and estrus but negative in proestrous. In ovariectomized rats, VDR was not detected in any layers of vaginal epithelium. CONCLUSION(S): In vaginal epithelium, the presence of VDR was shown by using immunohistochemical techniques. During the estrous cycle, VDR has an important role in the proliferation and differentiation of vaginal squamous epithelium that is similar to the effects of estrogen.     

Efficacy of anti-adhesive barriers in secondary thyroidectomy: an experimental study

HYPOTHESIS: This study was conducted to compare the effectiveness of two anti-adhesive barriers (Seprafilm and Interceed) for reducing adhesions after thyroidectomy in a rat model. The anti-adhesive barriers are suggested for use in repeated surgeries in general and the gynecologic fields in particular. STUDY DESIGN: Controlled, randomized study. METHODS: Twenty-eight male Wistar Albino rats that underwent right subtotal thyroidectomy were randomly assigned to three groups. One group received Seprafilm (n = 10), and the other received Interceed (n = 10) as anti-adhesive barriers. The third group was the control group (n = 8). At postoperative day 14, the rats were killed under general anesthesia, and the surgical fields were evaluated for the adhesion formation. The extent of the adhesion formation is scored from 0 (no adhesions) to 2 (fibrous adhesions that required sharp dissection). Histopathologically, chronic inflammation, histiocyte, fibroblast, fibrosis, collagen, vascularization, granuloma, giant cell, and fat necrosis were examined. RESULTS: All the subjects in the control group, 7 of 10 in the Interceed group, and 4 of 10 in the Seprafilm group needed to be dissected bluntly or sharply. There was significant difference between the Seprafilm and the control group (P < .05) whereas there was no significant difference between the Interceed group and the control group (P > .05). When examined histopathologically, the criteria showing adhesion, such as fibrosis, fibroblast, and collagen were higher in the control group compared with the Seprafilm and Interceed groups. There was no significant difference between the Seprafilm and Interceed groups, whereas a significant difference was found between these two groups and the control group. CONCLUSION: This study suggests that both Seprafilm and Interceed decrease the incidence of posthyroidectomy adhesions in a rat model. Both agents showed no foreign body reaction.     

Plasma transforming growth factor beta1 levels in thrombocytopenic and nonthrombocytopenic neonates

In this study, we determined the plasma TGF-beta1 levels in healthy and thrombocytopenic and nonthrombocytopenic neonates who had perinatal risk factors and examined the association between plasma TGF-beta1 levels and platelet counts in these newborns to investigate the role of TGF-beta1 in the pathogenesis of neonatal thrombocytopenia. Three groups were defined in this prospective study: group 1, thrombocytopenic neonates (n=22) who had perinatal risk factors; group 2, nonthrombocytopenic neonates who had similar perinatal risk factors for thrombocytopenia (n=20); group 3, healthy and nonthrombocytopenic neonates without any risk factors (n=20). Plasma TGF-beta1 levels were measured with ELISA. Plasma TGF-beta1 levels of the thrombocytopenic neonates were significantly lower than those of healthy nonthrombocytopenic neonates but did not differ significantly from nonthrombocytopenic neonates who had similar perinatal risk factors for thrombocytopenia. There was a significant positive correlation between plasma TGF-beta1 levels and platelet counts. Further studies are needed to determine the cause of low plasma TGF-beta1 levels in thrombocytopenic neonates and to investigate the role of plasma TGF-beta1 levels in the pathogenesis of neonatal thrombocytopenia.     

Role of perineal sonography in the evaluation of patients with stress urinary incontinence

OBJECTIVE: The aim of the study was to determine the role of perineal sonography in diagnosis of stress urinary incontinence. MATERIALS AND METHODS: Thirty patients with stress urinary incontinence and 17 age-matched control patients were included in the study. Perineal sonography was carried out in both groups to evaluate the role of this technique in the diagnosis of stress urinary incontinence. By using the posterior edge of the symphysis pubis as a reference point, posterior urethra-vesical angle (beta angle) and the angle between the vertical axis and urethral axis(alpha angle) were measured at rest and on straining. Bladder neck mobility was evaluated only at the cephalocaudal plane by measuring the desensus diameter. RESULTS: Posterior urethro-vesical angle (beta angle) was found to be significantly different between the study and control groups both at rest and on straining (P < 0.05). The angle between the vertical axis and urethral axis (alpha angle) was found to be significantly different between study and control groups only on straining (P < 0.05). Cephalocaudal distance (desensus diameter) was longer in patients with stress urinary incontinence (P < 0.05). CONCLUSION: Perineal sonography has an important role in diagnosing patients with stress urinary incontinence.