Bipolar vaporization of the prostate may cause higher complication rates compared to bipolar loop resection: a randomized prospective trial

International Urology and Nephrology - Transurethral resection of the prostate (TURP) by resection loop or vaporization button is becoming a standard of care due to its better safety profile (less...     

Nerve biopsy: requirements for diagnosis and clinical value

In many instances, nerve biopsy is not necessary in the diagnostic work-up of a peripheral neuropathy. However, histological examination of a tissue sample is still mandatory to show specific lesions in various conditions involving peripheral nerves. As there are fewer laboratories that examine human nerve samples, practitioners including neurologists and general pathologists may not be completely aware of the technical issues and data that are provided by nerve biopsy. Nerve biopsy is considered an invasive diagnostic method, although, its complications are by far less disabling than most of the disorders that lead to its indications. Nevertheless, the decision to perform a nerve biopsy has to be made on a case-by-case basis, and its results must be discussed between the pathologist and the clinician who is in charge of the patient’s care. In this paper, we review the minimal technical requirements for proper peripheral nerve tissue analysis. Moreover, we provide data on the usefulness of nerve biopsy in various situations including abnormal deposits, cell infiltrates, link between peripheral neuropathy and monoclonal gammopathy, and numerous hereditary disorders.     

Cortisol precursors in neonates with vasopressor-resistant hypotension in relationship to demographic characteristics

Objective: To correlate between cortisol precursors in neonates with vasopressor resistant hypotension and demographic characteristics.

Methods: We investigated 48 neonates with vasopressor-resistant hypotension. Gestation at birth ranged from 34 to 42 weeks and postnatal age from 4 to 14 days. Cortisol and precursor steroids were measured soon after the onset of volume expansion and inotropes for treatment of shock. Their concentrations were determined using liquid chromatography/mass spectrometry.

Results: In neonates with vasopressor-resistant hypotension, the serum levels of cortisol were within normal nonstress range. There was a strong negative linear association between postnatal age and dehydroepiandrosterone level (r?=??0.50, p?r?=?0.33, p?=?.02). No further significant associations were evident between the neonatal weight, duration of gestation or gender and of the levels of cortisol or the other steroids (p?>?.05). The cause of therapy-resistant hypotension did not appear to influence the steroid levels.

Conclusions: Cortisol stress response is absent in these severely ill late preterm and term infants. This may be due to inhibition of the distal pathway of cortisol synthesis.     

Intra-articular fibroma of tendon sheath of the shoulder joint: synovial fibroma

The case of a 30-year-old woman with multiple loose bodies in the shoulder joint is presented. The patient complained of discomfort of her right shoulder. Conventional radiographs failed to reveal any abnormality of the shoulder. On MRI numerous loose bodies were detected that resembled synovial chondromatosis. Histologically, the loose bodies were composed of a benign fibroblastic lesion with diagnostic features of fibroma of tendon sheath, each surfaced by synoviocytes. The clinicopathologic features of intra-articular fibroma of tendon sheath are reviewed. We propose using the term “synovial fibroma” for tumors with histopathologic features of fibroma of tendon sheath arising in the synovium of joints.     

Neurological manifestations and neuroradiological presentation of Erdheim-Chester disease: report of 6 cases and systematic review of the literature

Erdheim-Chester disease (ECD) is a rare, non-Langerhans form of histiocytosis of unknown etiology that affects multiple organs. We report 6 cases of ECD with neurological involvement and neuroradiological abnormalities on brain MRI. A literature review revealed 60 other cases of ECD with neurological involvement. We therefore analyzed 66 ECD patients with neurological involvement. Cerebellar and pyramidal syndromes were the most frequent clinical manifestations (41% and 45% of cases), but seizures, headaches, neuropsychiatric or cognitive troubles, sensory disturbances, cranial nerve paralysis or asymptomatic lesions were also reported. Neurological manifestations were always associated with other organ involvement, especially of bones (at least 86%) and diabetes insipidus (47%). Neurological involvement was responsible for severe functional handicaps in almost all patients and was responsible for the death of 6 of the 66 patients (9%). Neuroradiological findings could be separated into three patterns: the infiltrative pattern (44%), with widespread lesions, nodules or intracerebral masses, the meningeal pattern (37%), with either thickening of the dura mater or meningioma-like tumors, and the composite pattern (19%), with both infiltrative and meningeal lesions. Received in revised form: 21 October 2005     

Tunisian Women's Perceptions of Desirable Body Size and Chronic Disease Risk

The purpose of this study was to assess attitudes towards body size of urban Tunisian women. Firstly, to determine body size satisfaction amongst women and investigate the body size that women associate with good health, high social status and individual desirability; and secondly, to study whether perception varies in different groups of society, to see if there is a difference of attitudes in younger women and those of higher socioeconomic status. A cross-sectional, population based study was conducted in a peri-urban area of the capital, Tunis with 203 randomly selected women, aged 18–52 years. They were asked to associate 31 items with 1 of 6 photographic silhouettes of different body size; BMI was measured and over half of women were overweight or obese (BMI ≥ 25kg/m²). Almost two-thirds of all women were dissatisfied with their current body size. A normal body size (BMI 20–24 kg/m²) was seen in the most positive light by Tunisian women, although some positive attributes were associated with overweight silhouettes. Obesity was seen as undesirable, associated with greediness and poor health. There was no marked preference by younger women for slimmer body sizes, as had been expected. However, there was a preference by women with higher socioeconomic status for slimmer body sizes for some items. The finding that Tunisian women did not prefer larger body sizes may suggest a preference for a slimmer norm, closer to that in Western societies.