Delayed life-threatening haematuria from a renal pseudoaneurysm caused by blunt renal trauma treated with selective embolization

Pseudo-aneurysms complicating blunt renal traumas, although very rare, represent significant causes of secondary haematuria, potentially life-threatening. Initial surgical repair of the injured kidney does not preclude the presence of an obscure pseudo-aneurysm that could become evident later on. We herein present a patient with a grade III blunt renal trauma initially treated surgically. Thirty days after the trauma, he developed secondary haematuria caused by a renal pseudo-aneurysm located far from the oversewed area. This vascular lesion was successfully treated using selective arterial embolization.     

Administration of methylprednisolone to prevent severe ovarian hyperstimulation syndrome in patients undergoing in vitro fertilization

OBJECTIVE: To determine whether administration of methylprednisolone to high-risk women undergoing IVF/ICSI helps reduce the development of OHSS.DESIGN: Retrospective clinical controlled study.SETTING: IVF unit.PATIENT(S): One thousand ten women who underwent IVF/ICSI from January 9, 1997, to December 31, 1999. Ninety-one patients who were at high risk for OHSS were identified by using standard criteria.INTERVENTION(S): Methylprednisolone, 16 mg/d starting on day 6 of the stimulation and tapered after the first pregnancy test (day 13 after embryo transfer).MAIN OUTCOME MEASURE(S): Occurrence of OHSS.RESULT(S): A significantly lower proportion of methylprednisolone recipients than untreated participants developed OHSS (10.0% vs. 43.9%). Treatment recipients had more oocytes retrieved and more embryos fertilized than did untreated participants. Methylprednisolone treatment was equally effective in preventing OHSS in all causes of infertility and was effective independent of the number of IVF trials and pregnancy rates.CONCLUSION(S): Treatment with methylprednisolone appears to reduce the risk for OHSS. This treatment thus helps to avoid hospitalization, reduces cycle cancellations, and improves the cost-effectiveness of IVF cycles.     

Prolonged survival of an HIV-infected patient with plasmablastic lymphoma of the oral cavity

Plasmablastic lymphoma is an aggressive subtype of diffuse large B-cell lymphoma that is mainly observed in patients with the human immunodeficiency virus (HIV) infection, and it tends to arise in the oral cavity. We present a case of an HIV-infected patient with plasmablastic lymphoma with prolonged survival. The 30-yr-old woman was found to have an oral lesion at the time of the diagnosis of HIV infection. Histological and immunochemical examination of biopsy of the oral lesion showed plasmablastic lymphoma (CD138+). She received two cycles of cyclophosphamide, vincristine, doxorubicin, and prednisolone (CHOP) that started 10 weeks after the initiation of antiretroviral therapy. The continuing pancytopenia and an adenoviral febrile infection did not permit further antineoplastic treatment. A gradual decrease of the oral lesion was noted after the second cycle of chemotherapy that led to the disappearance of the lesion 7 months later. The patient remains in complete remission 61 months after the diagnosis of plasmablastic lymphoma.     

Insulin sensitivity assessment with euglycemic insulin clamp in adult beta-thalassaemia major patients

Objective: To assess insulin sensitivity in young adult normoglycemic β‐thalassaemia major patients. Methods: We measured insulin sensitivity with the euglycemic insulin clamp in 10 young adult (mean age 24.85 ± 2.45 yrs) normoglycemic β‐thalassaemia major patients and 10 sex‐ & age‐ matched controls. Liver iron accumulation was assessed by magnetic resonance imaging (MRI). Results: Glucose infusion rate (M) required to maintain euglycemia was significantly reduced in thalassaemic patients compared to controls (261.5 ± 63.5 mg/m²·min vs. 355.6 ± 35.3 mg/m²·min, P = 0.008). Consequently, significantly reduced in the thalassaemic group were also tissue sensitivity to insulin (M/I_s‐s) and glucose metabolic clearance rate (M/G_s‐s). There was significant negative correlation between ferritin levels and glucose infusion rate (r = ?0.918 P = 0.004). No significant correlations were observed between age, body mass index, daily transfusional iron accumulation, liver iron content and any of the euglycemic clamp parameters. Fasting insulin levels were significantly increased in patients with β‐thalassaemia major compared to controls (P = 0.01), and had significant negative correlation to MRI‐derived liver iron content (r = ?0.733, P = 0.03). Conclusions: Our data indicate that reduced insulin sensitivity resulting in hyperinsulinaemia precedes the manifestation of glucose intolerance in patients with β‐thalassaemia major. Insulin resistance seems to correlate with increased serum ferritin levels.     

Endovascular Treatment of a Bleeding Secondary Aorto-Enteric Fistula. A Case Report with 1-Year Follow-up

We report a patient with life-threatening gastrointestinal bleeding caused by a secondary aorto-enteric fistula. Because the patient had several comorbid conditions, we succesfully stopped the bleeding by endovascular placement of a bifurcated aortic stent-graft. The patient developed periaortic infection 4 months later, but he was managed with antibiotics. The patient is well 1 year after the procedure.     

Forefoot complaints--the Morton's metatarsalgia. The role of MR imaging

An illustrated case with Morton's metatarsalgia is presented. MR imaging was helpful for determining the presence, location and magnitude of intermetatarsal neuroma. Moreover, it had a large influence on the differential diagnostic thinking because many disorders may produce forefoot complaints mimicking Morton's metatarsalgia.     

CT Diagnosis of an Abortion-Related Retroperitoneal Space Abscess

A female patient with a history of recent abortion was transferred in critically ill condition in our hospital. CT imaging on emergency basis depicted an abscess in the right retroperitoneal space that included the head of fetus, along with rupture of the right lateral wall of uterus. Spiral CT enabled prompt diagnosis and therapy of this rare abortion-related complication. KEYWORDS: CT-Spiral; Uterus; Complication; Rupture; Obstetrics.     

Non-invasive 24 hour ambulatory monitoring of aortic wave reflection and arterial stiffness by a novel oscillometric device: The first feasibility and reproducibility study

Background

Surrogates of aortic wave reflection and arterial stiffness, such as augmentation index (AIx), augmentation pressure, pulse wave velocity (PWV) and pulse pressure amplification (PPampl) are independent predictors of cardiovascular risk. A novel ambulatory, brachial cuff-based oscillometric device has been recently developed and validated, yielding 24-h assessment of the aforementioned parameters (Mobilo-O-Graph). Aim of this study was to investigate the feasibility and reproducibility of wave reflection and arterial stiffness estimation by pulse wave analysis using this device.

Methods

Thirty treated or untreated hypertensives (mean age: 53.6 ± 11.6 years, 17 men) had test–retest 24-h monitoring one week apart using the test device.

Results

Mean numbers of valid aortic readings per subject, between test and retest, were comparable. Approximately 12 aortic readings per subject (17%) were not feasible or valid. No differences were observed for any 24-h parameter between the two assessments. Bland–Altman plots showed no systemic difference, while the limits of agreement for each parameter indicated high reproducibility (AIx: − 7.2 to 8.2%, AP: − 3.7 to 4.1 mm Hg, PWV: − 0.39 to 0.41 m/s, PPampl: − 0.08 to 0.06). This was further verified by intraclass correlation coefficients which were > 0.8 for each parameter.

Conclusions

Non-invasive 24-h estimation of wave reflection and arterial stiffness indices, derived by the test device, appear to be highly reproducible. Future studies should investigate whether these measurements have additive prognostic value for cardiovascular risk stratification, beyond common brachial blood pressure measurements or single estimations of wave reflection and PWV at office settings.     

Genotypic diversity of coagulase-negative staphylococci causing endocarditis: a global perspective

Coagulase-negative staphylococci (CNS) are important causes of infective endocarditis (IE), but their microbiological profiles are poorly described. We performed DNA target sequencing and susceptibility testing for 91 patients with definite CNS IE who were identified from the International Collaboration on Endocarditis-Microbiology, a large, multicenter, multinational consortium. A hierarchy of gene sequences demonstrated great genetic diversity within CNS from patients with definite endocarditis that represented diverse geographic regions. In particular, rpoB sequence data demonstrated unique genetic signatures with the potential to serve as an important tool for global surveillance.