Post-traumatic high-flow priapism treated by endovascular embolization using N-butyl-cyanoacrylate

Background

Priapism, persistent erection without arousal, can be classified into low-flow (venous or ischemic) and high-flow (arterial or non-ischemic). The diagnosis of high-flow priapism can be confirmed by colour Doppler and arteriography and it is usually treated by the endovascular embolization.

Case report

We present a case of a 20-year-old man with a post-traumatic high-flow priapism as a result of the previous perineal trauma. After a period of watchful waiting and an unsuccessful attempt at endovascular embolization using the resorptive gelatinous foam he was successfully treated by the endovascular embolization using N-butyl-cyanoacrylate.

Conclusions

High-flow priapism can be successfully treated by the endovascular embolization, but the optimal choice of the embolization agent and a careful technique is essential.     

Prolonged coexistence of transient and permanent circuitry elements in the developing cerebral cortex of fetuses and preterm infants

The aim of this paper is to evaluate correlative magnetic resonance imaging (MRI) and histological parameters of development of cortical afferents during pathfinding and target selection in transient fetal cerebral laminas in human fetuses and preterm infants. The transient fetal subplate zone, situated between the fetal white matter (i.e. intermediate zone) and the cortical plate, is the crucial laminar compartment for development of thalamocortical and corticocortical afferents. The prolonged coexistence of transient (endogenously active) and permanent (sensory-driven) circuitry within the transient fetal zones is a salient feature of the fetal and preterm cortex; this transient circuitry is the substrate of cerebral functions in preterm infants. Another transient aspect of organization of developing fibre pathways is the abundance of extracellular matrix and guidance molecules in periventricular crossroads of projection and corticocortical pathways. Both the subplate zone and periventricular crossroads are visible on MRI in vivo and in vitro. Hypoxic-ischaemic lesions of periventricular crossroads are the substrate for motor, sensory, and cognitive deficits after focal periventricular leukomalacia (PVL). Lesions of distal portions of the white matter and the subplate zone are the substrate for diffuse PVL. The neuronal elements in transient fetal zones form a developmental potential for plasticity after perinatal cerebral lesions.     

Apical leakage of five root canal sealers after one year of storage

A fluid transport model study was used to compare the sealing ability of five root canal sealers (AH26, AH Plus, Apexit, Diaket, and Ketac-Endo) on 60 single-rooted teeth after 1 yr of storage. The root canals were prepared with Gates Glidden drills by using a step-back technique before lateral condensation of gutta-percha with the tested sealers. The specimens were stored in saline solution for 1 yr at 37 degrees C. The leakage was measured by the movement of an air bubble in a capillary glass tube connected to the experimental root section. Apexit (0.490 microl) leaked significantly more than AH Plus (0.378 microl) and Ketac-Endo (0.357 microl), whereas AH26 (0.390 microl) and Diaket (0.429 microl) showed no significant difference from either Apexit or from AH Plus and Keto-Endo.     

Alpha-1-antitrypsin deficiency in early childhood

Alpha-1-antitrypsin deficiency (AATD), which predisposes liver disease in children, is often undiagnosed. Isoelectric focusing in 161 infants with liver dysfunction revealed 14.7% severe and 12.2% moderate AATD. Positive PAS-D and immunohistochemical staining was found in 60% of severe AATD, but in moderate AATD, only immunohistochemistry was positive in 100%. Bilirubinostasis, hepatomegaly, splenomegaly, cholestasis, hepatomegaly associated with cholestasis, acholia, high transaminases, and low birthweight were significantly more frequent in severe than in moderate AATD. Both AATDs showed significant portal inflammation, hepatic fibrosis, and viral infection. Early screening in children with liver dysfunction can contribute to the successful detection of AATD.     

The development of cerebral connections during the first 20-45 weeks' gestation

We have correlated data on neuroanatomical organization and magnetic resonance imaging of transient fetal zones shown to contain connectivity elements (growing axons, synapses, dendrites). In the fetal phase, afferent fibres ‘wait’ within the subplate zone which is the most prominent lamina on histological and magnetic resonance images and is a substrate of endogenous neuronal activity. In early preterm the thalamocortical afferents accumulate within the superficial subplate and grow into cortical plate developing synapses. In late preterm, the resolution of the subplate and growth of cortico-cortical fibres into the cortical plate occur simultaneously with gyration. Both preterm phases characterize the coexistence of endogenous and sensory-driven circuitries and occurrence of the transient electrical phenomena. In neonates, the long cortico-cortical pathways stop growth, and the main histogenetic events are an elaboration of intracortical circuitry and synaptogenesis. In conclusion, the growth of the axonal pathways preterm explains their vulnerability and plasticity. In neonates the vulnerability is related to the intracortical circuitry.     

The assessment of normal early pregnancy by transvaginal color Doppler ultrasonography

Transvaginal color Doppler was performed in 198 volunteer pregnant women whose menstrual age ranged from the fifth to the twelfth week. In all patients an attempt was made to obtain signals from both uterine arteries, peritrophoblastic/retroplacental vessels, umbilical arteries, fetal aorta, intracranial vessels, and corpus luteum flow. With the combination of color and pulsed Doppler transvaginal sonography, detection of vascular structures was greatly facilitated and the amount of time for examination significantly reduced. Flow velocity waveforms were measured and results were analyzed by calculation of the Resistance Index. During the early stage of pregnancy, we were able to locate both uterine arteries in all cases and continuous diastolic shift signal was found. Flow in the peritrophoblastic/retroplacental area was observed with an overall success rate of 94%. Blood flow in the umbilical artery and fetal aorta was visualized by color Doppler starting from the seventh week. Intracranial blood flow could be visualized starting from the tenth week in some cases. Diastolic flow in these vessels was detectable starting from the twelfth week. Corpus luteum flow was found in 148 cases (75%) and the Resistance Index decreased as pregnancy progressed © 1993 by John Wiley & Sons, Inc.     

Changes in neuronal activity of cortico‐basal ganglia–thalamic networks induced by acute dopaminergic manipulations in rats

The basal ganglia are thought to be particularly sensitive to changes in dopaminergic tone, and the realization that reduced dopaminergic signaling causes pronounced motor dysfunction is the rationale behind dopamine replacement therapy in Parkinson's disease. It has, however, proven difficult to identify which neurophysiological changes that ultimately lead to motor dysfunctions. To clarify this, we have here recorded neuronal activity throughout the cortico‐basal ganglia–thalamic circuits in freely behaving rats during periods of immobility following acute dopaminergic manipulations, involving both vesicular dopamine depletion and antagonism of D1 and D2 type dopamine receptors. Synchronized and rhythmic activities were detected in the form of betaband oscillations in local field potentials and as cortical entrainment of action potentials in several basal ganglia structures. Analyses of the temporal development of synchronized oscillations revealed a spread from cortex to gradually also include deeper structures. In addition, firing rate changes involving neurons in all parts of the network were observed. These changes were typically relatively balanced within each structure, resulting in negligible net rate changes. Animals treated with D1 receptor antagonist showed a rapid onset of hypokinesia that preceded most of the neurophysiological changes, with the exception of these balanced rate changes. Parallel rate changes in functionally coupled ensembles of neurons in different structures may therefore be the first step in a cascade of neurophysiological changes underlying motor symptoms in the parkinsonian state. We suggest that balanced rate changes in distributed networks are possible mechanism of disease that should be further investigated in conditions involving dopaminergic dysfunction.     

Coronavirus epidemic in Croatia: case fatality decline during summer?

AimTo describe the SARS-CoV-2 epidemic pattern in Croatia during February-September 2020 and compare the case fatality ratio (CFR) between spring and summer.MethodsNational data were used to calculate the weekly and monthly CFRs, stratified by three age groups: 0-64, 65-79, and 80+ years. We also calculated the standardized mortality ratios (SMR) to offset the differences in age composition.ResultsThe epidemic consisted of the initial wave, a trough in June, and two conjoined summer waves, yielding 17 206 coronavirus disease 2019 cases and 290 deaths. While the number of confirmed cases nearly quadrupled during summer, case fatality estimates decreased; CFR in spring was 4.81 (95% confidence interval 3.91-5.71), compared with 1.24 (1.06-1.42) in summer. The SMR for summer was 0.45 (0.37-0.55), suggesting that the case fatality risk halved compared with spring. Cardiovascular comorbidity was an important risk factor for case fatality (SMR 2.63 [2.20-3.13] during spring and 1.28 [1.02-1.59] during summer). The risk of death in ventilated patients remained unchanged (SMR 0.98 [0.77-1.24]).ConclusionsThe epidemic dynamics suggests summer decline in case fatality, except in ventilated patients. While the effect of comorbidity also decreased, cardiovascular comorbidity remained an important risk factor for death even during summer. A plethora of possible confounders and an ever-changing landscape of SARS-CoV-2 epidemic in Croatia require constant monitoring and evaluation, with an aim to prevent the uncontrolled spread of the virus and a disruption of health care functioning.

The understanding of the seasonal pattern of SARS-CoV-2 spread and coronavirus disease 2019 (COVID-19) symptoms severity is not of only academic significance, but plays a central role in the epidemic preparedness (1-4). For the Northern hemisphere, the issues currently of the greatest importance are the prediction of the autumn and winter disease spread and mortality (5). Previous articles have most commonly confirmed the expected role of seasonality (6), often with an explanation that higher temperature reduces the virus spread during summer (7-9). On the other hand, some studies have shown that we may not expect a substantial seasonality pattern, suggesting that SARS-CoV-2 may not behave like a common seasonal respiratory pathogen (10-12). A recent systematic review confirmed the existence of some degree of seasonality, but also stated that it may not be the only or the critical variable that will define the pandemic patterns (13).There are various possible causes underlying the seasonal pattern of the pandemic, including changes in temperature and humidity (14-17), or wind speed and air pollution (18). Additionally, unfavorable conditions were reported to affect the ability of respiratory mucosa to fend off (19), which suggests a possible synergistic effect between numerous factors. An important distinction needs to be made by separately addressing the viral spread and case fatality, since the two might not exhibit similar patterns. The recognition of such differences may shed more light on the disease pathogenesis, and possibly even steer the path toward mechanisms of epidemic control. However, studies that made this distinction often report the expectation that for Europe, an increase in humidity will lower the number of new cases and deaths, while a rise in temperature will increase these parameters (20). Although such predictions are very sensitive to numerous modeling input parameters and assumptions, none can be superior to the epidemiological ex post-facto analysis. Several such articles suggested lowering of the summer case fatality (9,21), but this finding was not replicated systematically across all studies (22). Therefore, the aim of this study was to explore the epidemic pattern in Croatia, with a special focus on understanding the difference in the disease spread and case fatality during the spring and summer of 2020.