Dermatophyte pseudomycetoma: a case report

A 25-year-old man presented with several prominent subcutaneous masses in the occipital region of the scalp. He had a long history of tinea capitis and tinea corporis infection. Histopathology of the occipital lesions showed mycelial aggregates in the deep dermis and subcutis. Cultures of the excised material and superficial scales grew a fungus identified as Microsporum ferrugineum. We propose the term ‘dermatophyte pseudomycetoma’ to describe this distinctive mycosis.     

苯系物对接触女工生殖内分泌的影响

目的 :探讨苯系物对接触女工生殖内分泌激素的影响。方法 :调查对象按月经周期的不同时相 ,即月经期、增殖期、排卵期、分泌期各抽血一次 ,采用放射免疫法测定性激素。结果 :苯系物对接触女工月经周期中的LH平均含量有抑制作用 ,对月经周期的不同时相内性激素进行比较 ,增殖期E2 接触组显著低于对照组 ,t =2 83(P <0 0 1) ,分泌期LH含量接触组显著低于对照组t=2 81(P <0 0 1)。而月经周期内FSH、P两组间差异无统计学意义。结论 :接触苯系物对女工血清中的部分性激素具有抑制作用。     

Regulation of GLUT4 protein and glycogen synthase during muscle glycogen synthesis after exercise

The pattern of muscle glycogen synthesis following its depletion by exercise is biphasic. Initially, there is a rapid, insulin independent increase in the muscle glycogen stores. This is then followed by a slower insulin dependent rate of synthesis. Contributing to the rapid phase of glycogen synthesis is an increase in muscle cell membrane permeability to glucose, which serves to increase the intracellular concentration of glucose-6-phosphate (G6P) and activate glycogen synthase. Stimulation of glucose transport by muscle contraction as well as insulin is largely mediated by translocation of the glucose transporter isoform GLUT4 from intracellular sites to the plasma membrane. Thus, the increase in membrane permeability to glucose following exercise most likely reflects an increase in GLUT4 protein associated with the plasma membrane. This insulin-like effect on muscle glucose transport induced by muscle contraction, however, reverses rapidly after exercise is stopped. As this direct effect on transport is lost, it is replaced by a marked increase in the sensitivity of muscle glucose transport and glycogen synthesis to insulin. Thus, the second phase of glycogen synthesis appears to be related to an increased muscle insulin sensitivity. Although the cellular modifications responsible for the increase in insulin sensitivity are unknown, it apparently helps maintain an increased number of GLUT4 transporters associated with the plasma membrane once the contraction-stimulated effect on translocation has reversed. It is also possible that an increase in GLUT4 protein expression plays a role during the insulin dependent phase.     

Role of Bladder Dysfunction in Men with Lower Urinary Tract Symptoms Refractory to Alpha‐blocker Therapy: A Video‐urodynamic Analysis

Objectives

Lower urinary tract symptoms (LUTS) in men result from a complex interplay of pathophysiology, including bladder and bladder outlet dysfunction. This study retrospectively analyzed bladder dysfunction in men with LUTS based on the results of video‐urodynamic studies (VUDS).

Methods

Male patients (aged ≥40 years), with LUTS and an International Prostate Symptom Score of 8 or more, who were refractory to alpha‐blocker treatment were retrospectively recruited and evaluated with VUDS and total prostate volume (TPV). Patients were further divided into subgroups of bladder dysfunction and bladder outlet dysfunction according to characteristic VUDS findings. Age, TPV and VUDS findings were compared among different subgroups.

Results

After VUDS, bladder outlet obstruction (BOO) was only noted in 48.6% of men. Of patients, 919 of 2991 (30.7%) had bladder dysfunction including detrusor underactivity (DU, 5.1%), detrusor overactivity and inadequate contractility (DHIC, 5.3%), detrusor overactivity (DO, 17%) and hypersensitive bladder (HSB, 3.3%). In addition, 1941 (64.9%) had bladder outlet dysfunction including BOO + DO (33.8%), BOO alone (14.8%), and poor urethral sphincter relaxation (PRES, 16.3%). Among the 1519 patients with DO, 66.6% (1012) had BOO while, among 1454 patients with BOO, 69.5% (1010) had DO. Patients with DHIC, DU and DO were 5 years older than patients with HSB and normal men. TPV was significantly smaller in patients with DHIC, DU and DO as compared with BOO + DO.

Conclusion

Approximately one‐third of male LUTS was due to bladder dysfunction. A man older than 70 years with LUTS and TPV less than 30 mL usually indicates the presence of bladder dysfunction rather than BOO.     

Difficult Urination Does Not Affect the Successful Outcome after 100U OnabotulinumtoxinA Intravesical Injection in Patients with Idiopathic Detrusor Overactivity

Objectives: Intravesical injection of onabotulinumtoxinA (i.e. Botox) provides effective treatment for overactive bladder. However, treatment‐related adverse events (AEs) remain problems. This study investigated the effect of AEs after onabotulinumtoxinA injection on the success rate for idiopathic detrusor overactivity (IDO). Methods: A total of 174 patients who received the first single intravesical onabotulinumtoxinA 100U injection for refractory IDO were included. The onabotulinumtoxinA related AEs including acute urinary retention (AUR), large postvoid residual (PVR, ≥150 mL), difficult urination, urinary tract infection, gross hematuria and general weakness were recorded. The success rate was determined based on patient perception of bladder condition improved by two scales. The short‐term (3 months) and long‐term (up to 24 months) success rates were analyzed according to the occurrence of these AEs. Results: A successful outcome was reported by 138 (79.3%) patients at 3 months. AUR occurred in 12 (6.9%) patients, large PVR developed in 81 (46.6%) and 73 (42%) needed straining to void. Gross hematuria occurred in 17 (9.8%) patients, urinary tract infection developed in 27 (15.5%) and general weakness was noted in 6 (3.4%). The occurrence of AUR did not affect the therapeutic results. Patients having large PVR and difficult urination had a significantly higher success rate at 3 months. Long‐term success rates up to 24 months showed no significant difference between patients with and without AEs. Conclusions: AEs after intravesical 100U onabotulinumtoxinA for IDO were frequently encountered. However, the occurrence of AUR, large PVR or difficult urination did not affect the final therapeutic outcome.     

Camptocormia as a presentation of generalized inflammatory myopathy

Camptocormia is an abnormal truncal flexion posture that occurs while walking or standing. It is usually caused by various hypokinetic movement disorders such as Parkinson disease and multiple system atrophy. Myopathy or motor neuron disease can also be infrequent causes of camptocormia. Paraspinous muscle biopsy usually reveals focal myositis, regardless of the etiology of camptocormia. We describe the first case of generalized inflammatory myopathy with prominent camptocormia and proximal muscle weakness. Muscle biopsy of the quadriceps confirmed the diagnosis of polymyositis, and the posture showed modest improvement in response to steroid treatment. Muscle Nerve, 2009