Intestinal pseudo-obstruction caused by neuromyopathy in a patient with systemic sclerosis

Although gastrointestinal involvement in systemic sclerosis is common, the pathophysiology of small-bowel involvement in systemic sclerosis is not fully understood. We report a case of a 56-year-old woman who has systemic sclerosis with intestinal pseudo-obstruction. The small-bowel manometric findings showed low-amplitude intestinal contraction and absence of the migrating myoelectric complex, and the electrogastrography revealed no increase of the slow-wave power. The manometric and electrogastrographic findings demonstrate that neuromyopathy may play a role in pseudo-obstruction of systemic sclerosis.     

Phosphodiesterase-5 gene (PDE5A) polymorphisms are associated with progression of childhood IgA nephropathy

The phosphodiesterase-5 (PDE-5) gene is highly specific to cyclic GMP (cGMP) and several experimental studies have shown that the nitric oxide/cGMP pathway plays an important role in the pathogenesis of glomerulonephritis, including IgA nephropathy (IgAN). The present study was conducted to investigate the association among 16 single nucleotide polymorphisms (SNPs) of PDE5A and childhood IgAN. The genotyping data from 160 patients with childhood IgAN and 454 controls showed a significant difference in rs13124532 (codominant, P = 0.005; dominant, P = 0.005). Furthermore, patient subgroup analysis revealed an association between the development of proteinuria (>4 and ≤4 mg/m²/h) and rs13124532 (codominant, P = 0.008; dominant, P = 0.011), and between the nephrotic range proteinuria (> 40 mg/m²/h) and rs11734241 (dominant, P = 0.035), rs12510138 (dominant, P = 0.028), rs13134665 (dominant, P = 0.025), rs3822192 (dominant, P = 0.027), rs10013305 (dominant, P = 0.020), rs1480940 (dominant, P = 0.020), rs1480936 (dominant, P = 0.019), rs11947234 (dominant, P = 0.019), and rs2127823 (dominant, P = 0.026). The pathological findings showed that rs13124532 had an association with podocyte foot process effacement (codominant, P = 0.035; dominant, P = 0.044) and with pathological progression (codominant, P = 0.046). Our results suggest that PDE5A is associated with increased disease susceptibility, pathological progression, and development of proteinuria in childhood IgAN.     

Surgical Outcomes and Prognostic Factors for T2 Gallbladder Cancer Following Surgical Resection

Background

Depth of tumor invasion is an important prognostic factor for gallbladder cancer. The aim of this study was to investigate the clinicopathological prognostic factors of T2 gallbladder cancer.

Methods

We retrospectively reviewed the clinicopathological data and survival for 83 patients with T2 gallbladder cancers who underwent surgical resection between January 1995 and December 2007.

Results

The overall survival rates were 48.9% at 3 years and 29.3% at 5 years. Univariate analysis revealed that R0 resection (P?<?0.001), extended surgery (P?=?0.028), lymph node dissection (P?=?0.024), non-infiltrative tumors (P?=?0.001), well differentiation (P?=?0.001), absence of lymphatic (P?=?0.025), perineural (P?=?0.001), and vascular (P?=?0.025) invasion, absence of lymph node metastasis (P?=?0.001), negative resection margin (P?=?0.016), and stage (P?=?0.002) were significantly better predictors for survival. A significant difference in survival between Rx and R1 was not found. R0 resection, lymph node dissection, well differentiation, and absence of perineural and vascular invasion were significantly independent prognostic factors for overall survival. Recurrence occurred in 48 patients (57.8%). Age older than 65 years, R0 resection, non-infiltrative tumors, and good differentiation were significant independent predictors of disease-free survival by multivariate analysis.

Conclusions

For T2 tumors, radical surgery including lymph node dissection should be performed to achieve R0 resection. Tumors with infiltrative types and suspicious lymph node metastasis in the intraoperative findings were candidates for aggressive surgical management to improve patient survival.     

Facet joint violation during pedicle screw insertion: a cadaveric study of the adult lumbosacral spine comparing the two pedicle screw insertion techniques

This article analyses the incidence of facet joint violation by pedicle screws inserted via the two most commonly used techniques, intersection and mammillary. Pedicle screws were inserted on each side of fresh-frozen human cadevaric specimen lumbosacral spines using the two techniques. All facet joints which were violated were found to be on the right side, where the mamillary process technique was employed. The incidence of facet joint violation was higher in the mammillary technique, which was statistically significant. The intersection technique appears to be safer than the mamillary with respect to violation of the adjacent superior facet joint.     

Acute-stage evolution of watershed infarction assessed on diffusion-weighted MR imaging

BACKGROUND: To investigate acute stage (<5 days) evolution of the watershed infarction (WI) on diffusion-weighted (DW) magnetic resonance (MR) imaging and to evaluate the role of perfusion MR imaging in predicting the progression of watershed infarction. METHODS: Twenty-eight patients with acute WI within 24 h after symptom onset were selected for this study. Criterion for WI was based on DW images. We assessed the infarct volume changes between the initial and follow-up (mean: 2.2 days) DW images. Perfusion images were obtained in 20 patients at the initial work-up and sensitivity, specificity, and accuracy of perfusion-diffusion mismatch in predicting severe infarct progression were evaluated. Clinical outcome was assessed by using National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). RESULTS: Infarct volumes on initial and follow-up DW images were 8.6+/-7.7 cm3 and 20.2+/-27.0 cm3, respectively. Twenty-one cases showed no or slight increment (<15 cm3) of infarct volume on follow-up MR imaging and seven cases showed severe progression (>15 cm3 increment). Among 20 cases in which perfusion maps were obtained, 5 cases showed perfusion-diffusion mismatch: among those, 4 developed severe progression of infarction. Severe progression group showed higher follow-up NIHSS score and poor outcome by 90-day mRS score. CONCLUSION: WI usually begins as a small volume lesion, and progression of infarction during the acute stage is usually limited in most cases. Perfusion imaging may have an important role in predicting severe infarct progression in WI.     

Femoral head stress fracture: an unknown complication following Sugioka's transtrochanteric rotational osteotomy

Sugioka's transtrochanteric rotational osteotomy, as a treatment of osteonecrosis of the femoral head, has variable success rates. Its known complications include: progressive varus deformity, femoral neck fracture, and femoral head collapse. However, femoral head stress fracture has not been described as a complication of Sugioka's transtrochanteric rotational osteotomy. This article presents cases of 2 of 64 patients who underwent Sugioka's transtrochanteric rotational osteotomy between 1994 and 2006 and experienced femoral head stress fractures. Both patients were young and active. They presented with acute inability to bear weight and pain on the operated hip after mountain climbing 1 and a half to 3 years following the index surgery. Diagnosis of femoral head stress fracture was established by the presence of an inferolaterally-directed vertical fracture line from the superolateral aspect of the femoral head on computed tomography scans for both patients. One patient was successfully managed with conservative measures, whereas the other underwent total hip replacement after failed conservative treatment. We hypothesize that the direction alteration of the trabecular system due to proximal femoral segment rotation, varus positioning of the proximal femur, and inadequate placement of the screw into the necrotic femoral head may have caused the femoral head stress fractures after transtrochanteric rotational osteotomies. Stress fracture of the femoral head is a potential complication following Sugioka's transtrochanteric rotational osteotomy for osteonecrosis of the femoral head, which may be prevented by avoiding heavy exercises such as mountain climbing, until adequate remodeling of the trabecular system is gained and screws can be inserted into the femoral head subchondral bone as deeply as possible with avoidance of the necrotic area.     

Alternative Therapies for the Treatment of Chronic Prostatitis

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a prevalent disease for which there is no standardized therapy. Traditional treatments have included antibiotics, α-blockers, and anti-inflammatories, but those have not proven to be efficacious therapies through many clinical trials. Alternative therapies, such as phytotherapy, acupuncture, and pelvic floor physical therapy, have grown in popularity for the treatment of CP/CPPS. As clinicians continue to explore these alternative therapies, there is an accumulation of strong evidence demonstrating the success of these alternative therapies.