Appendiceal mucocele and gangrenous cholecystitis

OBJECTIVE: We present a case report of appendiceal mucocele and gangrenous cholecystitis. SETTING: Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México, D.F. CLINICAL CASE: An 80-year-old man was admitted to the hospital with diagnosis of acute cholecystitis and abdominal tumor under study, with complaints of abdominal pain for 10 days located in the right upper quadrant, without fever or significant weight loss. Laboratory analyses revealed moderate leucocytosis. CT of the abdomen revealed thickening of the gallbladder wall and acute local inflammation, as well as the presence of abdominal tumor in the right lower quadrant. The patient was surgically explored with the following findings: gangrenous cholecystitis and appendiceal tumor of 20 cm length. Cholecystectomy and appendectomy was performed. The postoperative period was normal. The final histological report was appendiceal mucocele and the patient was discharged after 5 days. The patient is currently without complaints at 5 months postoperatively.     

Predictors of intrauterine insemination success

Intrauterine insemination (IUI) remains a therapeutic option within means of the majority of infertile couples in Malaysia. Therefore additional information on predictors of IUI success in the local context would provide a more concrete basis for counseling patients on expectations and treatment options. A retrospective analysis of 297 couples who underwent 445 IUI cycles from Jan 2005-Mar 2006 was undertaken. Four fifths were Malay with a mean paternal and maternal age of 35.53 +/- 5.82 (range 24-59) and 33.02 +/- 4.69 (range 21-46) years respectively. Causes of infertility were idiopathic (50%), endometriosis (17%) and anovulation/polycystic ovarian syndrome (15%). Almost 10% were oligoastenoteratozoospermic with another 23% oligozoospermic or astenozoospermic. Combined male and female factors occurred in 26%. A pregnancy rate (PR) of 9.4% per cycle; 14.1% per couple with a cumulative PR of 36.7% per 4 cycles was achieved. Those who became pregnant were significantly younger (31.29 +/- 4.43 vs. 33.21 +/- 4.68 years, p = 0.011) and had more follicles (13.95 +/- 9.72 vs. 11.43 +/- 6.67, p = 0.029) at the time of insemination. PR depreciated with maternal age and semen quality. Maternal and paternal age was inversely correlated to the number of follicles recruited (r = -0.30, p < 0.0005) and progressive sperm motility (r = -0.125, p = 0.013) respectively.     

Arthrogryposis, renal tubular acidosis and cholestasis (ARC) syndrome: two new cases and review

ARC syndrome, the association of arthrogryposis, renal tubular dysfunction and cholestasis, is a rare genetic disorder. We report two Saudi infants from two different families with ARC syndrome. Magnetic resonance imaging of the brain of one of the infants showed lissencephaly, a previously unreported finding in this syndrome. We also review 39 ARC cases reported in the literature using the Medline database from January 1966 to September 2004.     

Reactivity and Specificity of Trichinella spiralis Fractions in Cutaneous and Serological Tests

Six diethylaminoethyl-cellulose fractions of a larval Trichinella spiralis extract, an Ascaris suum extract, and a nonrelated protein were used for cutaneous tests in guinea pigs with 8-, 14-, and 73-day-old T. spiralis infections, in guinea pigs with 13-day-old A. suum infections, and in normal guinea pigs. A selected T. spiralis fraction was used in hemagglutination (HA) tests with sera of 8 T. spiralis-infected rabbits, 41 sera of trichinellosis patients positive by bentonite agglutination tests, and 50 sera of clinically healthy persons. Immediate-type cutaneous reactions revealed extensive cross-reactivity between both parasites, although the establishment of conventional limits for considering a reaction positive allowed the specific diagnosis of acute or chronic trichinellosis with different fractions. Delayed-type reactions were specific with all fractions except one, and different fractions reacted during either the acute or the chronic phase of trichinellosis. HA detected anti-Trichinella antibodies in all the rabbits 9 to 10 days postinfection, in all trichinellosis patients, and in none of the healthy people. Correlation between HA and bentonite agglutination titers and other considerations suggest that HA with the selected fraction detects early antibodies. HA inhibition tests with A. suum extract suggest lack of HA cross-reactivity between the A. suum- and T. spiralis-selected fractions. The use of different fractions in diverse tests for clinical or epidemiological studies is suggested.