Is Chlamydia pneumoniae a risk factor for peripheral atherosclerosis?

Seroepidemiological studies have shown a relationship between Chlamydia pneumoniae and coronary atherosclerosis. It is not clear whether Chlamydia pneumoniae is also a risk factor for peripheral atherosclerosis. Chlamydia pneumoniae antibodies were measured by a microimmunofluorescence method in 75 patients who underwent surgery for peripheral atherosclerosis, and the seroprevalence was compared with that in the normal population. Chlamydia pneumoniae immunoglobulin-G seroprevalence was 80% in the study group vs. 40% in controls. More foam cells were noted on light microscopy in atherosclerotic plaques from the infected patients. The 60 infected patients were divided into: group A (n = 35) given both anti-chlamydial and antiplatelet agents for 1 year; and group B (n = 25) given antiplatelet therapy only. The groups were compared on the basis of clinical findings, ankle-brachial index, and antibody titers. Decreasing Chlamydia pneumoniae immunoglobulin-G seroprevalence in group A correlated significantly with increasing ankle-brachial index and improvement in clinical findings. It was concluded that Chlamydia pneumoniae may be a risk factor for peripheral atherosclerosis.     

Simple provocative maneuvers in renal transplant scintigraphy for detecting urine leak

Urine leak in the early postoperative period following renal transplantation is a serious complication requiring early identification and aggressive intervention, which significantly reduces the morbidity and mortality. Renal transplant scintigraphy is a noninvasive method to evaluate the perfusion and function of a transplanted kidney and urinary drainage including urine leak. Here, we reported two cases in which the standard transplant renogram failed to demonstrate urine leak. The cases were referred for a diethylenetriaminepentaacetic acid renogram following the transplantation to evaluate the cause of symptoms or elevated serum creatinine level. In both the cases, urine leak was successfully detected following simple maneuvers such as diuretic administration or Foley catheter irrigation. Renal transplant scintigraphy is an effective and safe technique and the use of these simple maneuvers can enhance the diagnostic sensitivity of the transplant renogram in the detection of urine leak.     

Resolution of a fourth ventricle epithelial cyst after ventriculoperitoneal shunting: case report

BACKGROUND: Symptomatic cysts of epithelial origin occurring in the fourth ventricle are very rare. When such a cyst is encountered, the treatment strategy includes surgical removal or fenestration of the cyst into subarachnoid space. CASE 1: A 23-year-old male was diagnosed as having a cyst located in the fourth ventricle causing hydrocephalus; the patient underwent cyst removal via craniotomy. The histopathologic diagnosis was neuroepithelial cyst. Because clinical and neuroradiological findings persisted, he underwent VP shunting. The cyst disappeared and did not recur. CASE 2: A 54-year-old woman was diagnosed as having a cystic mass in the fourth ventricle and dilatation of the ventricles. Magnetic resonance imaging showed the same findings as those of the first case. The patient refused craniotomy for total mass excision. Therefore, a VP shunt was applied. Postoperatively, the clinical findings and hydrocephalus improved, and complete disappearance of the cystic mass was observed unexpectedly. Both cases had 2 years of follow-up. CONCLUSION: There is no proven mechanism to explain resolution of fourth ventricle cysts after a supratentorial VP shunting. We hypothesize that disappearance of the cyst could result from rupture of its wall because of pressure gradient, which might be facilitated by a VP shunt. The current report should not be taken as an argument against cyst removal, which is the established way of treatment. However, considering that the pathogenesis and pathophysiology of these cysts are unclear, VP shunting should be considered especially for recurrent cases accompanied by hydrocephalus.     

An upper thoracic spinal cord tumor presenting as hemifacial hyperhidrosis

BACKGROUND: Hyperhidrosis as the sole presenting symptom of an upper thoracic intramedullary tumor has never been reported in the English literature. CASE DESCRIPTION: A 17-year-old boy presented with a long history of hemifacial flushing and hyperhidrosis on the left side of his face and neck. The MRI revealed a large spinal cord tumor at the T1-T2 levels. The patient underwent total excision of the intramedullary tumor via a posterior myelotomy. The histopathological diagnosis was low-grade astrocytoma. The symptoms resolved immediately after the surgery and did not return during the follow-up period of 9 months. CONCLUSIONS: We suggest that sympathetic irritation on the left side is the mechanism behind this clinical presentation. Its unusual presentation and lack of motor and sensory deficits resulted in delayed diagnosis of this potentially disabling lesion. When autonomic dysfunction of the face and neck is encountered, in addition to the cranial and cervical regions, the upper thoracic levels should be investigated using MRI.     

Motor evoked responses from the thigh muscles to the stimulation of the upper limb nerves in patients with late poliomyelitis.

OBJECTIVES: To demonstrate a clear-cut M response recorded from the severely affected thigh muscles to the stimulation of the upper limb nerves in a serial of patients with late poliomyelitis. METHODS: Fifteen patients with late poliomyelitis, 7 patients with spinal cord disorders and 11 control subjects were included. Evoked muscle responses were investigated in quadriceps femoris and/or thigh adductor muscles to the stimulation of the brachial plexus, median and ulnar nerves. RESULTS: Evoked muscle responses were obtained from the thigh muscles in all 12 late polio patients with proximal lower extremity involvement. The response could not be recorded from the thigh muscles neither in the 3 polio patients with upper extremity involvement nor in the healthy control subjects and in patients with other spinal cord disorders of anterior horn cell. CONCLUSIONS: It is proposed that the electrical stimulation of the arm nerves produce interlimb descending muscle responses in the severely affected atrophic thigh muscles of the patients with late polio. This finding suggests that there might be a focal and/or specific loss of inhibitory interneurons between injured and normal motor neurons and increased facilitatory synaptic action at the end of long propriospinal descending fibers in the case of late poliomyelitis.     

A cadaveric histological investigation of the prostate with three-dimensional reconstruction for better results in continence and erectile function after radical prostatectomy

In this study our aim is to increase the understanding of the prostate and related organs anatomy for better continence and erectile function results after urological surgery. Prostate and related organs were dissected from seven cadavers. After dissection, 165 serial sections with 300 microm thickness were derived at a 100 microm interval. The histological images were examined and imported to the computer. Three-dimensional (3D) remodeling had been performed. The findings were evaluated into three categories: macroscopic, microscopic and 3D reconstruction. Striated muscle fibers had been detected at the anterior fibromuscular stroma in histological sections. In 3D remodeling, urethra seemed to be a complete functional unit, beginning from the trigone up to the membranous urethra. The neurovascular bundles run under the pelvic fascia on both sides and go through to the bladder neck at 5 and 7 o'clock. Computer remodeling demonstrated that neurovascular structures had a close association with the bladder neck and the seminal vesicle. Computer program made it possible to rotate all 3D-reconstructed figures by 360 degrees and examine them from all possible angles. All reconstructed structures can be examined together at the same time or one by one. Surgeons must pay special attention to the continence area described as a single unit, beginning from trigone to the membranous urethra, during the surgery. Meticulous dissection of the neurovascular bundles, especially close to the seminal vesicles and bladder neck, during the radical prostatectomy is necessary. These reconstructions can be used for the educational purpose of medical students as well as the urology surgeons.