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.

     

Histidine-rich protein 2 of the malaria parasite, Plasmodium falciparum, is involved in detoxification of the by-products of haemoglobin degradation

The histidine-rich protein 2 (PfHRP2) of Plasmodium falciparum has been implicated in the detoxification of ferriprotoporphyrin IX (FP) moieties that are produced as by-products of the digestion of haemoglobin. In this work, we have used a spectroscopic analysis to confirm that recombinant PfHRP2 binds FP. A monoclonal antibody that recognises both recombinant and authentic PfHRP2 was used in immunofluorescence microscopy studies. We found that PfHRP2 is mainly located in the erythrocyte cytosol of infected erythrocytes, however, dual labelling studies suggest that the location of a sub-population of the PfHRP2 molecules overlaps with that of the food vacuole-associated protein, P-glycoprotein homologue (Pgh-1). A semi-quantitative analysis of the level of PfHRP2 in infected erythrocytes suggests a concentration of a few micromolar in the food vacuole. Under conditions designed to mimic the parasite food vacuole, we found that 1.2 microM PfHRP2 is sufficient to catalyse the conversion of about 30% of a 100 microM sample of FP to beta-haematin within 24 h. Moreover, PfHRP2 is capable of promoting the H(2)O(2)-induced degradation of FP at pH 5.2. PfHRP2 also efficiently enhances the ability of FP to catalyse the H(2)O(2)-mediated oxidation of the model co-factor, ortho-phenylene diamine (OPD). These data suggest that PfHRP2 may promote the detoxification of FP and reactive oxygen species within the food vacuole. By contrast, PfHRP2 inhibits the destruction of FP by glutathione (GSH) at pH 7.4. This suggests that PfHRP2 is not a catalyst of FP degradation outside the food vacuole.     

Functional Reach and Lateral Reach Tests in Turkish Children

Aims: The functional reach test (FRT) and lateral reach test (LRT) provide important measures of postural stability. The aims of this study were to (1) establish the normative values for FRT and LRT, and (2) examine the effects of age, gender, and various anthropometric measurements on FRT and LRT. Methods: Two hundred eighty children, aged 6–12 years, completed the study. One hundred fifty-two subjects were females. The mean age was 9.0 ± 2.0 years. Each child performed two trials of FRT and LRT. Results: No significant differences were detected in any age group between males and females. The normal values of FRT ranged between 23.0 and 36.5 cm, and that of LRT between 18.0 and 28.0 cm. Height, length of upper and lower extremity, and arm span had a higher correlation with FRT. Age and weight showed a good correlation with FRT. Age, height, weight, length of upper and lower extremity, and arm span showed good correlation with LRT. Conclusions: These normative data will be useful for clinicians in the assessment of balance of individual children and in the diagnosis of potential balance deficits at an early age in the Turkish population.     

Dopamine-secreting adrenal ganglioneuroma presenting with paroxysmal hypertension attacks

Adrenal ganglioneuromas are rare tumors originating from the neural crest tissue of the sympathetic nervous system. The clinical presentation for most patients is asymptomatic, and most of these tumors are hormone silent. We report a case of dopamine-secreting adrenal ganglioneuroma associated with paroxysmal hypertensive attacks in an adult patient. A 46-year-old woman was admitted to our hospital with a 2-month history of right flank pain, and a 2-year history of paroxysmal hypertensive attacks associated with headaches, palpitations, nervousness, and sweating. Abdominal CT and MRI revealed a solid round tumor approximately 4 cm in diameter on the upper pole of the right kidney. Urinary levels of dopamine and homovanillic acid were slightly elevated, although urinary levels of metanephrine and normetanephrine were suppressed. The urinary levels of epinephrine, norepinephrine, and vanillylmandelic acid were within normal limits. Right adrenalectomy was performed for treatment purposes. Histological diagnosis of the tumor was a ganglioneuroma originating from the adrenal medulla. In conclusion, this is a case of dopamine-secreting adrenal ganglioneuroma associated with paroxysmal hypertensive attacks in an adult patient.     

比较糖尿病和非糖尿病患者超声乳化术超乳参数和黄斑厚度的变化

目的：调查无视网膜病变的糖尿病和非糖尿病患者接受普通白内障手术时,应用具有前房稳定环境（ CASE）和加强控制和效率（ ICE ）的微脉冲超乳技术对患者超乳参数和黄斑中心凹厚度（ CFT）变化的影响。方法：前瞻性研究。研究包含120例患者,其中60例患者为2型糖尿病患者,设为糖尿病组（无视网膜病变）,另60例设为对照组。所有患者均接受普通白内障超声乳化术。术中记录超乳参数,包括超乳时间和有效超乳时间。术前和术后1、3 mo检测记录 CFT并计算每次检测中 CFT的差异。结果：糖尿病组的平均超乳时间为1．40±0．43min,而对照组为1．44±0．32min,差异无统计学意义（P＝0．85）。糖尿病组平均有效超乳时间为20．12±8．82s,对照组为19．24±9．02s,差异无统计学意义（P＝0．964）。糖尿病组术前平均CFT为218．4±12．0μm,对照组为222．1±16．6μm,差异无统计学意义（ P＝0．168）。术后1mo糖尿病组CFT平均增加30．3±37．2μm,对照组平均增加13．1±12．5μm。术后1 mo两组CFT明显增加,糖尿病组显著高于对照组（P＝0．001）。术后3mo糖尿病组和对照组的平均CFT较术前分别增加12．5±12．4μm与4．6±9．7μm。糖尿病组CFT的增加显著高于对照组（ P＝0．00）。但分别比较糖尿病组和对照组术后1 mo至3 mo平均CFT变化,会发现两组均显著减少（P＝0．00,P＝0．03）。结论：普通超乳手术会使CFT显著增加。糖尿病组和对照组的超乳参数相似。糖尿病组CFT变化大于对照组,但这些症状大部分表现为亚临床,并且仅显示于光学相干断层扫描（ OCT）的改变。术后3mo这种变化会恢复或消失,无需治疗。     

Microbiological diagnostics of bloodstream infections in Europe—an ESGBIES survey

ObjectivesHigh-quality diagnosis of bloodstream infections (BSI) is important for successful patient management. As knowledge on current practices of microbiological BSI diagnostics is limited, this project aimed to assess its current state in European microbiological laboratories.MethodsWe performed an online questionnaire-based cross-sectional survey comprising 34 questions on practices of microbiological BSI diagnostics. The ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis (ESGBIES) was the primary platform to engage national coordinators who recruited laboratories within their countries.ResultsResponses were received from 209 laboratories in 25 European countries. Although 32.5% (68/209) of laboratories only used the classical processing of positive blood cultures (BC), two-thirds applied rapid technologies. Of laboratories that provided data, 42.2% (78/185) were able to start incubating BC in automated BC incubators around-the-clock, and only 13% (25/192) had established a 24-h service to start immediate processing of positive BC. Only 4.7% (9/190) of laboratories validated and transmitted the results of identification and antimicrobial susceptibility testing (AST) of BC pathogens to clinicians 24 h/day. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry from briefly incubated sub-cultures on solid media was the most commonly used approach to rapid pathogen identification from positive BC, and direct disc diffusion was the most common rapid AST method from positive BC.ConclusionsLaboratories have started to implement novel technologies for rapid identification and AST for positive BC. However, progress is severely compromised by limited operating hours such that current practice of BC diagnostics in Europe complies only partly with the requirements for optimal BSI management.