Necrotizing fasciitis of the perineum

Background

Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries a high mortality rate and requires prompt diagnosis and urgent treatment with radical debridement and antibiotics; but early diagnosis, which is essential to successful treatment, remains a challenge.

Methods

Physical examination findings, preoperative and operative findings, histopathological results of the structure, and follow-up results of the patient are discussed with related reports.

Results

A 15-month old girl had a history of trivial perineal dermatitis after treatment of anemia and pneumonia. Perineal dermatitis progressed fastly as necrotizing fasciitis which was successfully managed with intensive medical treatment, surgical debridement and reconstructive surgery.

Conclusions

Lack of cutaneous findings early in the disease makes the diagnosis challenging, so a high suspicion is essential. Recovery of the patient from this life-threatening condition needs a multi-disciplinary approach involving pediatrics, pediatric surgery, and plastic and reconstructive surgery.     

Treatment of iatrogenic internal carotid artery laceration and carotid cavernous fistula with endovascular stent-graft placement

The risk of fatal injury of the internal carotid artery (ICA) and surrounding anatomy during transsphenoidal surgery for pituitary adenoma is the most severe potential complication associated with this particular approach. We present a case in which iatrogenic injury to a patient's ICA and resultant carotid cavernous fistula and massive hemorrhage was successfully managed with the emergency placement of an endovascular stent-graft. Both findings in the relevant literature and practical considerations concerning both stent-grafts and other more commonly used options for the treatment of iatrogenic ICA injury are discussed.     

Intrathecal gadolinium-enhanced MR cisternography in patients with otorhinorrhea: 10-year experience of a tertiary referral center

Purpose

Despite a considerable amount of literature that has been published about the use of intrathecal gadolinium-enhanced MR cisternography (IGE-MRC), there is still relatively lack of evidence as to its long-term effects. Our purpose in this study was twofold: firstly, to assess the long-term safety of the IGE-MRC; secondly, to evaluate the diagnostic performance of IGE-MRC for detecting cerebrospinal fluid (CSF) leak in otorhinorrhea patients.

Methods

We retrospectively reviewed our imaging and clinical database for the patients admitted to our department for the evaluation of their otorhinorrhea between 2008 and 2017. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the long-term follow-up.

Results

The retrospective review yielded 166 patients. Rhinorrhea was present in 150 (90.4%) patients and otorrhea in 16 (9.6%) patients. Overall, 67 patients (40.5% of all patients) underwent operation for repair of the CSF leak site. Beta-transferrin test was available and positive in 57 (34.3%) patients. Overall sensitivity of IGE-MRC and paranasal high-resolution CT (HRCT) was 89.3 and 72%, respectively. Within the first 24 h after the procedure, none of the patients experienced a significant complication or adverse reaction. Ninety-nine patients (59.6%) had medical record and telephone follow-up. The mean follow-up duration with call was 37.1 months. Three (3%) patients complained about severe headache 3–4 weeks after the procedure.

Conclusions

IGE-MRC is a minimally invasive and highly sensitive imaging technique. No adverse side effect during our long-term follow-up might strengthen and support the safety of IGE-MRC.

     

Regulatory volume decrease by cultured non-pigmented ciliary epithelial cells.

Cells (ODM C1-2/SV40) derived from human non-pigmented ciliary epithelial cells were studied by electronic cell sizing. The time course of the cell volume (vc) was monitored after suspending cells in paired experimental and control, isosmotic and hyposmotic solutions of identical ionic composition. Following anisosmotic cell swelling, the cells displayed the regulatory volume decrease (RVD) previously described. The RVD primarily reflects loss of cell KCl since: (1) the K(+)-channel blockers quinidine and Ba2+ both inhibit the RVD; and (2) replacement of external Cl- with gluconate or addition of the Cl- channel blocker NPPB also inhibits the RVD. Bicarbonate has previously been reported to speed the RVD. This action likely reflects pH dependence of the channels since: (1) increasing the external pH speeds the RVD, whether or not HCO3- is present; and (2) DIDS (a blocker of Cl- channels and of Cl-/HCO3- exchange) is an effective inhibitor of the RVD, even after blocking Cl-/HCO3- exchange by removing external HCO3-. The RVD could also be inhibited by reducing the availability of Ca2+, either by omitting Ca2+ from the external medium or by blocking mobilization of intracellular Ca2+ with TMB-8. Furthermore, the RVD was slowed and incomplete in the presence of the calcium/calmodulin blocker trifluoperazine. We conclude that anisosmotic swelling triggers a series of events, mediated at least in part by calcium/calmodulin, leading to the extrusion of KCl through parallel K+ and Cl- channels.     

Dissecting aneurysms of posterior communicating artery itself: anatomical, diagnostic, clinical, and therapeutical considerations

Posterior communicating artery (PCoA) itself is an unusual location for intracranial aneurysms in that isolated dissections or dissecting aneurysms are extremely rare. In the way of correct diagnosis of dissecting aneurysms of PCoA itself, a proper understanding of (1) the anatomy of the PCoA and its perforator branches, (2) some particular diagnostic features, and (3) related clinical aspects is of significant importance. Although there are no established treatment strategies for this particular type of aneurysms, the endovascular approach might be considered as a plausible one. In this paper, our scope was to report five cases with dissecting aneurysm of the PCoA itself and to discuss this rare vascular pathology from anatomical, diagnostic, clinical, and therapeutical perspectives.     

Allergic myocardial infarction in childhood: Kounis syndrome

Kounis Syndrome was first described by Kounis as “allergic angina syndrome” progressing to “allergic myocardial infarction”. This report describes the first children in the literature presented with Kounis syndrome.     

Correction to: Galectin-1 and Galectin-3 Levels in Patients with Schizophrenia and their Unaffected Siblings

Psychiatric Quarterly - The original version of this article unfortunately contained a mistake. The name of the 5th author was incorrectly listed as Çi?dem Yüksel, when it is...     

MRI findings of hypoxic cortical laminar necrosis in a child with hemolytic anemia crisis

European Radiology - We present magnetic resonance imaging findings of a 5-year-old girl who had a rapidly installing hemolytic anemia crisis induced by trimethoprim–sulfomethoxazole,...