Vesicouterine fistulae: our experience of 17 cases and literature review

Aim

A retrospective study of vesicouterine fistulae managed from 1996 to 2011 analyzed the incidence, symptomatology, diagnosis, and surgical outcome.

Patients & methods

During the study period, 17 patients were managed, of whom 14 underwent abdominal repair and three underwent vaginal repair. Mean patient age was 31.1 years and mean follow-up 7.3 years.

Results

Vesicouterine fistulae resulted following cesarean section in 13 patients and vaginal delivery in four. Eleven patients presented with urinary leakage via the vagina and seven with menouria. All patients had successful outcomes irrespective of treatment approach. The uterus was conserved in ten patients, of whom seven had completed their childbearing. The remaining three conceived spontaneously and underwent elective cesarean section.

Conclusion

The majority of vesicouterine fistulae occur following cesarean section, and it is feasible to achieve 100 % successful repair. Though the majority require abdominal repair, a few selected cases can be successfully repaired vaginally.     

Impaired neurogenesis is an early event in the etiology of familial Alzheimer's disease in transgenic mice

Formation of new neurons in the adult brain takes place in the subventricular zone and in the subgranule layer of the dentate gyrus throughout life. Neurogenesis is thought to play a role in hippocampus‐ and olfaction‐dependent learning and memory. However, whether impairments in neurogenesis take place in learning and memory disorders, such as Alzheimer's disease, is yet to be established. Importantly, it remains to be elucidated whether neurogenic impairments play a role in the course of the disease or are the result of extensive neuropathology. We now report that transgenic mice harboring familial Alzheimer's disease‐linked mutant APPswe/PS1ΔE9 exhibit severe impairments in neurogenesis that are evident as early as 2 months of age. These mice exhibit a significant reduction in the proliferation of neural progenitor cells and their neuronal differentiation. Interestingly, levels of hyperphosphorylated tau, the cytotoxic precursor of the Alzheimer's disease hallmark neurofibrillary tangles, are particularly high in the neurogenic niches. Isolation of neural progenitor cells in culture reveals that APPswe/PS1ΔE9‐expressing neurospheres exhibit impaired proliferation and tau hyperphosphorylation compared with wildtype neurospheres isolated from nontransgenic littermates. This study suggests that impaired neurogenesis is an early critical event in the course of Alzheimer's disease that may underlie memory impairments, at least in part, and exacerbate neuronal vulnerability in the hippocampal formation and olfaction circuits. Furthermore, impaired neurogenesis is the result of both intrinsic pathology in neural progenitor cells and extrinsic neuropathology in the neurogenic niches. Finally, hyperphosphorylation of the microtubule‐associated protein tau, a critical player in cell proliferation, neuronal maturation, and axonal transport, is a major contributor to impaired neurogenesis in Alzheimer's disease. © 2010 Wiley‐Liss, Inc.     

Congenital lower brachial plexus palsy due to cervical ribs

Congenital brachial plexus palsy (CBPP) usually occurs secondarily to intrapartum trauma, but this is not always the case. Cervical ribs have previously been reported to increase the risk of CBPP in association with birth trauma. We report the cases of two children (one female, one male) with congenital lower brachial plexus palsy in whom the presence of non-ossified cervical ribs was the only identified risk factor. In the female child magnetic resonance imaging (MRI) of the brain, spinal cord, and brachial plexus revealed no abnormality except for the presence of bilateral cervical ribs at the level of the seventh cervical (C7) vertebra. Chest radiography was normal, which suggested that the cervical ribs identified on the MRI were fibrous bands or cartilaginous ribs rather than ossified ribs. In the male child, MRI of the spine and brachial plexus was normal but he was noted to have bilateral cervical ribs at C7. These were not identifiable on chest radiography and, therefore, are likely to reflect fibrous bands or cartilaginous ribs.     

Ocular alterations in patients of alopecia areata

There is paucity of published work on ocular alterations in patients of alopecia areata (AA), especially from the Asian continent. We studied the clinical profile of 83 patients of AA and 80 sex- and age-matched controls to assess and compare the ocular changes, namely punctate opacities, cataract, intraocular tension and retinal changes. The outcome was analyzed with respect to prevalence of atopy, concomitant personal or family history of autoimmune diseases and nail changes in both the groups. The prevalence of atopy and family history of autoimmune diseases was significantly higher in the patient group. Lenticular changes were observed in 40.9% patients (including cataract in 16.9%) and 11.2% controls ( P  < 0.005). Within the patient group, lenticular involvement occurred with increased frequency in atopics ( P  = 0.034) and in the presence of family history of autoimmune diseases ( P  < 0.05). Retinal changes in the form of degenerative changes, pigmentary clumping and abnormal vascular changes were more prevalent ( P  < 0.001) in the study group. As the ocular changes were not found to correlate with the age, severity or extent of the disease, an initial ophthalmological screening of all patients is suggested.     

Rosai-Dorfman disease manifesting as intracranial and intraorbital lesion

Rosai-Dorfman disease is a rare benign idiopathic histioproliferative disorder usually manifesting as massive painless adenopathy. Extranodal involvement of the Central Nervous System (CNS) mimicking a skull base meningioma is rare. A 42-year-old male presented with painless, progressive left visual loss of 4 months duration. Clinically, he had a left ptosis, proptosis and ophthalmoplegia. Magnetic Resonance Imaging (MRI) of the brain with gadolinium revealed a destructive lesion of the left orbital apex, middle cranial fossa and cavernous sinus. He was treated with corticosteroids and underwent debulking. Pathology showed inflammatory infiltrate in the absence of an infectious agent, emperipolesis and a positive S100 stain was consistent with Rosai-Dorfman disease. As there was no improvement following steroids and debulking, he underwent radiation therapy with significant improvement of his symptoms. Although a rare entity, Rosai-Dorfman disease should be considered in the differential of a skull base lesion.     

Use of yeast-secreted in vivo biotinylated recombinant antibodies (Biobodies) in bead-based ELISA.

PURPOSE: To measure circulating antigens, sandwich ELISA assays require two complementary affinity reagents. Mouse monoclonal antibodies (mAb) and polyclonal antibodies (pAb) are commonly used, but because their production is lengthy and costly, recombinant antibodies are emerging as an attractive alternative. EXPERIMENTAL DESIGN: We developed a new class of recombinant antibodies called biobodies (Bb) and compared them to mAb for use in serodiagnosis. Bbs were secreted biotinylated in vivo by diploid yeast and used as affinity reagents after Ni purification. Bead-based assays for HE4 and mesothelin were developed using Bbs in combination with pAbs (Bb/pAb assays). To assess precision, reproducibility studies were done using four runs of 16 replicates at six analyte levels for each marker. Pearson correlations and receiver-operator characteristic analyses were done in 214 patient serum samples to directly compare the Bb/pAb assays to mAb assays. Diagnostic performance of the Bb/pAb assay was further assessed in an expanded set of 336 ovarian cancer cases and controls. RESULTS: On average across analyte levels, Bb/pAb assays yielded within-run and between-run coefficients of variations of 11.7 and 23.8, respectively, for HE4 and 14.0 and 14.5, respectively, for mesothelin. In the subset (n = 214), Pearson correlations of 0.95 for HE4 and 0.92 for mesothelin were observed between mAb and Bb/pAb assays. The area under the curves for the mAb and Bb/pAb assays were not significantly different for HE4 (0.88 and 0.84, respectively; P = 0.20) or mesothelin (0.74 and 0.72, respectively; P = 0.38). CONCLUSION: Yeast-secreted Bbs can be used reliably in cost-effective yet highly sensitive bead-based assays for use in large validation studies.     

Encephalopathy associated with acute measles

Thirty children presenting with acute encephalopathic illness within a month of measles were studied. A male preponderance was found and 83.3% of cases were below 5 years of age. The interval between onset of measles rash and that of encephalopathy ranged from 0 to 20 days. Fever (96.6%), convulsions (70%), and coma (90%) were found in a high percentage of cases, while focal neurological deficits and abnormal movements were found in a small number of patients (3.3% and 16.6% respectively). Signs of cerebellar or medullar involvement were not seen. Only 1 (3.3%) case had pleocytosis in the cerebrospinal fluid. Eleven (36.6%) patients died in hospital. The pathogenesis of acute encephalopathy following measles is discussed. An erratum to this article is available at .     

Dermatitis herpetiformis and rheumatoid arthritis

A 35- year-old deaf and dumb woman with clinical and histopathological diagnosis of dermatitis herpetiforrnis (DH) is reported for its rare association with rheumatoid arthritis (PA).