Subcutaneous phaeohyphomycosis caused by Cladophialophora boppii

Subcutaneous phaeohyphomycosis is an infection of the skin and subcutaneous tissue, caused by dematiaceous fungi. An adult male presented with a history of multiple reddish nodules over the face and hands. Histopathological examination of the skin biopsies showed a dense granulomatous infiltrate of macrophages, containing intracytoplasmic basophilic bodies throughout the dermis. Gomori methenamine-silver stained sections revealed yeast cells within macrophages. Multiple cultures on Sabouraud's dextrose agar grew Cladophialophora boppii. The patient was treated with oral itraconazole for a year and the response monitored with dermal ultrasound. This is the first case report of subcutaneous phaeohyphomycosis caused by Cl. boppii in India.     

Peripheral Polyneuropathy and Female Sexual Dysfunction—Familial Amyloidotic Polyneuropathy as an Example Besides Diabetes Mellitus

IntroductionFemale sexual dysfunction (FSD) in peripheral polyneuropathies besides diabetes mellitus is still a poorly studied subject. Little is known about sexual function in women with amyloidosis, Guillain–Barré syndrome, or porphyria. Even for the world's most common peripheral polyneuropathies such as diabetes mellitus, knowledge and consensus are still lacking. Familial amyloidotic polyneuropathy (FAP) is the most common cause of genetic systemic amyloidosis, with neurological clinical manifestations similar to diabetes mellitus. Until today, no study on the sexual function of these young female patients has been published.AimTo evaluate FSD in female FAP patients and to compare the results with those of healthy, non‐FAP females.MethodsA questionnaire‐based, observational study comprising 94 nonmenopausal women with a sexual partner (51 FAP and 43 non‐FAP as the control group) was conducted. The Female Sexual Function Index (FSFI)—Portuguese‐validated version was used to assess FSD.Main Outcome MeasuresTotal and subscales scores of the FSFI.ResultsFSD was reported by 42% (95% confidence intervals [CI] 28.3–55.7) of FAP patients compared to 12% of healthy controls. Of all the FAP patients, 39.2% reported problems with desire (95% CI 25.6–52.4), 72.5% reported problems with arousal (95% CI 60.2–84.8), 68% reported lubrication problems (95% CI 55.1–80.9), 62% reported orgasm problems (95% CI 48.5–75.5), 39.2% experienced pain (95% CI, 25.8–52.6), and 49% experienced sexual dissatisfaction (95% CI, 35.3–62.7).Even after multiple logistic regression analysis, FAP is associated with sexual dysfunction in women (OR 4.3, 95% CI 1.2–15.5, P < 0.03), and the affected domains are desire (OR 5.1, 95% CI 1.3–19.7, P < 0.02), arousal (OR 4.7, 95% CI 1.5–14.1, P < 0.007), orgasm (OR 5, 95% CI 1.6–16, P < 0.007), and sexual satisfaction (OR 4.8, 95% CI 1.4–16.9, P < 0.02). Only the use of medication with potential for sexual dysfunction was found as a significant predictor of orgasm disorder (OR 4.2, 95% CI 1.1–15.6, P < 0.03), as did age for sexual dissatisfaction (OR 1.1, 95% CI 1.0–1.2, P < 0.04).ConclusionsFAP as a peripheral polyneuropathy results in FSD, presenting a risk factor four times greater and related to disease severity in terms of desire, arousal, and orgasm disorders, as well as sexual dissatisfaction. Oliveira‐e‐Silva T, Campos Pinheiro L, Rocha Mendes J, Barroso E, and Monteiro Pereira N. Peripheral polyneuropathy and female sexual dysfunction—Familial amyloidotic polyneuropathy as an example besides diabetes mellitus. J Sex Med 2013;10:430-438.     

Abordaje histeroscópico del endometrio residual en muñón cervical

The main difference between subtotal and total hysterectomy lies in the persistence of the cervical stump and the possible associated problems. One of these problems is cyclical bleeding after a subtotal hysterectomy, which, depending on the series, occurs in 0% to 25% of cases. We describe resolution of cyclical bleeding after a subtotal hysterectomy by means of hysteroscopic treatment. To our knowledge, this is the first published case in which ablation of the remnant tissue was performed with a monopolar loop in order to treat cyclical bleeding. We believe this surgical treatment could be a valid alternative to resolve cyclical bleeding associated with persistence of endometrial tissue in the cervical stump.     

Correlation between visual examination of the cervix and digital examination

Objective.?To determine the correlation between visual assessment of the cervix and digital examination.

Methods.?Prospective study of patients presenting to Labor and Delivery. Exclusion criteria were preterm premature ruptured membranes (PPROM) and placenta previa. Visual and digital assessments of cervical dilation, effacement, position, and station of fetal presenting part were made. Correlation between visual and digital examinations was measured using Spearman rank correlation coefficient (COR). A p-value <?0.05 was considered significant.

Results.?The study involved a total of 107 patients at a mean gestational age of 32.3 weeks (range 17–41). Seven patients had ruptured membranes, and 46 were nulliparous. Visual assessment correlated with digital examination for all parameters measured with Spearman rank correlation coefficients between 0.618 and 0.686 (all significant at p?<?0.001). Correlations between visual and digital assessment of cervical dilation, effacement, station, and position were not as strong (0.291–0.699), but remained significant (p?<?0.02) in a subgroup of 50 preterm patients <?34 weeks gestation.

Conclusion.?Visual assessment correlates with digital examination of the cervix. This correlation remained significant in a subset of preterm patients with intact membranes.     

Motion correction and myocardial perfusion SPECT using manufacturer provided software. Does it affect image interpretation?

Purpose  

Myocardial perfusion SPECT is an excellent tool for the assessment of coronary artery disease (CAD); however, it is affected by several artifacts, such as patient motion during acquisition, which increases false-positive rates. Therefore, the purpose of this work is to analyze changes in perfusion scores after motion-correction software application.     

Contemporary management of primary parapharyngeal space tumors

The parapharyngeal space is a complex anatomical area. Primary parapharyngeal tumors are rare tumors and 80% of them are benign. A variety of tumor types can develop in this location; most common are salivary gland neoplasm and neurogenic tumors. The management of these tumors has improved greatly owing to the developments in imaging techniques, surgery, and radiotherapy. Most tumors can be removed with a low rate of complications and recurrence. The transcervical approach is the most frequently used. In some cases, minimally invasive approaches may be used alone or in combination with a limited transcervical route, allowing large tumors to be removed by reducing morbidity of expanded approaches. An adequate knowledge of the anatomy and a careful surgical plan is essential to tailor management according to the patient and the tumor. The purpose of the present review was to update current aspects of knowledge related to this more challenging area of tumor occurrence.     

Complications and reoperations after surgery for 647 patients with spine metastatic disease

Background Context

Postoperative morbidity may offset the potential benefits of surgical treatment for spine metastatic disease; hence, risk factors for postoperative complications and reoperations should be taken into considerations during surgical decision-making. In addition, it remains unknown whether complications and reoperations shorten these patients' survival.

Alterations to the Gut Microbiome Impair Bone Strength and Tissue Material Properties

Alterations in the gut microbiome have been associated with changes in bone mass and microstructure, but the effects of the microbiome on bone biomechanical properties are not known. Here we examined bone strength under two conditions of altered microbiota: (1) an inbred mouse strain known to develop an altered gut microbiome due to deficits in the immune system (the Toll‐like receptor 5–deficient mouse [TLR5KO]); and (2) disruption of the gut microbiota (ΔMicrobiota) through chronic treatment with selected antibiotics (ampicillin and neomycin). The bone phenotypes of TLR5KO and WT (C57Bl/6) mice were examined after disruption of the microbiota from 4 weeks to 16 weeks of age as well as without treatment (n = 7 to 16/group, 39 animals total). Femur bending strength was less in ΔMicrobiota mice than in untreated animals and the reduction in strength was not fully explained by differences in bone cross‐sectional geometry, implicating impaired bone tissue material properties. Small differences in whole‐bone bending strength were observed between WT and TLR5KO mice after accounting for differences in bone morphology. No differences in trabecular bone volume fraction were associated with genotype or disruption of gut microbiota. Treatment altered the gut microbiota by depleting organisms from the phyla Bacteroidetes and enriching for Proteobacteria, as determined from sequencing of fecal 16S rRNA genes. Differences in splenic immune cell populations were also observed; B and T cell populations were depleted in TLR5KO mice and in ΔMicrobiota mice (p < 0.001), suggesting an association between alterations in bone tissue material properties and immune cell populations. We conclude that alterations in the gut microbiota for extended periods during growth may lead to impaired whole‐bone mechanical properties in ways that are not explained by bone geometry. © 2017 American Society for Bone and Mineral Research.