Investigation of HSV-1, HSV-2, CMV, HHV-6 and HHV-8 DNA by real-time PCR in surgical resection materials of epilepsy patients with mesial temporal lobe sclerosis

OBJECTIVE: The objective of this study is to investigate the presence of viral DNAs of HSV-1, HSV-2, HHV-6, HHV-8, and CMV in hippocampus of the patients with mesial temporal lobe epilepsy (MTLE) syndrome. METHODS: Pathological specimens were obtained from 33 patients with MTLE undergone temporal lobectomy with amygdalo-hippocampectomy due to intractable seizures. Autopsy materials from the hippocampus of 7 patients without neurological disease were used as controls. The data was also correlated with the clinical history of patients including febrile convulsions, age, and history of CNS infections. Real-time polymerase chain reaction method was performed for detection of DNAs of these viruses. RESULTS: HHV-6, HSV-1 and HHV-8 were detected in the hippocampus of 3, 2 and 1 patients with MTLE respectively. None of the hippocampus of patients with MTLE was positive for DNA of HSV-2 and/or CMV. Three patients with positive HHV-6 DNAs had febrile convulsions and family history for epilepsy. None of our control specimens showed PCR positivity to any of the 5 tested viruses. CONCLUSIONS: Our study is the first to report the presence of HHV-8 viral genome in the brain tissue of patient with MTLE. Viral DNAs were detected in a total of 18% of the patients in this study; we can conclude that activity of the latent virus in patients with hippocampal sclerosis should be more extensively studied to establish its role in active infection.     

Cystic olfactory schwannoma of the anterior cranial base

Olfactory groove schwannomas are extremely uncommon and less than 30 cases are reported in the literature. We report a 21-year-old developmentally-retarded boy who experienced severe headache and aggressive behaviour for 5 months. Imaging showed a cystic mass in the subfrontal region, which was removed by craniotomy. The lesion had a vascular supply from the anterior ethmoidal arteries and it was noted to be attached to the right olfactory nerve. It was removed completely and histology showed it to be a schwannoma. Olfactory groove schwannomas are rare lesions and should be differentiated from meningiomas, neuroblastomas and dural-based metastatic lesions of the anterior cranial base.     

Changes in the smooth muscle of the corpora cavernosum related to reversal of partial bladder outlet obstruction in rabbits

Previous studies have demonstrated that partial bladder outlet obstruction (PBOO) in the rabbit induces an increase in corpus cavernosum smooth muscle (CCSM) tone, which may make it difficult for the CCSM to relax. Thus, to determine whether the corpus cavernosum restores relaxation after reversal of PBOO, we investigated the physiologic, histologic, and cell biology in penises obtained from rabbits 4 weeks and 8 weeks after reversal of PBOO. CCSM from bladder outlet-obstructed and obstruction-reversed rabbits showed significant decreases in the contractile responses to phenylephrine. The relaxation responses to electrical field stimulation (EFS), ATP, acetylcholine, and sodium nitroprusside (SNP) were decreased in obstructed and reversed for 4 weeks groups. By 8 weeks of reversal, the relaxation of CCSM was increased gradually in response to EFS, SNP, and acetylcholine. However, the response to ATP did not result in the relaxation of CCSM to control levels. The ratio of SM to collagen decreased after obstruction and remained low after reversal. Expression of both isoforms of Rho kinase (ROK) was increased in obstruction groups. At 4 weeks of reversal, the expression of ROK alpha remained at obstruction level, whereas ROK beta expression decreased in comparison with the obstruction group. By 8 weeks of reversal, expression of both ROK alpha and beta significantly decreased when compared with the obstruction group. These results suggested that the poor relaxation response at reversal of 4 weeks was associated with incomplete decreased expression of both isoforms of ROK, whereas the incomplete recovery of the CCSM relaxation response at reversal of 8 weeks may be associated with structural alterations in the CC and irreversible damage from PBOO.     

Erectile dysfunction and Peyronie’s disease in patient with retroperitoenal fibrosis

Objective  The aim of this study is to determine the sexual dysfunction in patient with retroperitoneal fibrosis (RPF) and also we explored probability of Peyronie’s disease (PD) in this patient group and to compare this with the controls. Materials and methods  Ten of 17 male RPF patients formed the basis of this study. Patient’s age, concomitant diseases were recorded. The diagnosis of PD was based on a palpable penile plaque or acquired penile curvature. Age-matched 88 patients who were admitted to our outpatient clinic with elevated PSA level served as the control group. All patients were asked to complete the IIEF-5 questionnaire. The severity of the erectile dysfunction (ED) was classified into four categories: severe (5–7), moderate (8–16), mild (17–21), and no ED (22–25). Concomitant systemic diseases were recorded. Statistical analyses were done by the Fisher’s exact test and an unpaired-sample t-test. Results  Patients with severe ED or no sexual intercourse in the study group and the control group during the study period were found to be 7 and 14, respectively. The median IIEF-5 score in RPF patients and the control group was 9.8 (min: 5 to max: 23) and 19 (min: 5 to max: 25), respectively. The differences between groups were statistically significant (P = 0.002). In particular, ED was reported in eight RPF patients (80%) which was severe in six (60%) and moderate in two (20%). ED was reported in 45 patients in the control group (51%) which was severe in 14 (15.9%), mild in 25 (28.4%), and moderate in six (6.8%). Patients with RPF had a significant tendency for severe ED compared with the control group (P = 0.0042). Two patients in the RPF group (20%) and one patient in the control group (1.1%) were found to have a penile plaque (P = 0.0279). Relative risk for developing a penile plague was found to be 0.8 in RPF. Conclusion  RPF patients are found to be more prone to developing ED. Penile plaque formation was identified in RPF patients, which may be presumed to relate to the pathological changes of the RPF process, but it remains unclear that these patients demonstrate a higher incidence of plaque formation than the normal population.     

Undescended testis in older boys: further evidence that ascending testes are common

Introduction

We recommend orchiopexy between 9 and 18 months of age for surgical, testicular, and psychological reasons. However, in practice, we observed many patients coming to orchiopexy at a later age. To understand this difference better, we reviewed our experience with patients undergoing late orchiopexy.

Methods

We reviewed retrospectively the office medical records of all boys who had undergone an orchiopexy between July 1997 and April 2006. We defined a “late” orchiopexy as that performed at 4 years of age or later. Each boy was examined carefully by a pediatric urologist, and preoperative, intraoperative, and postoperative findings were reviewed.

Results

There were 191 late orchiopexies in 177 patients (from a total of 587 orchiopexies in 552 patients). Median age at the operation was 7.2 years (range, 4.0-16.2). Preoperatively, the testes were palpable in 140 (72%) and nonpalpable in 51 (28%). The apparent reason for the late orchiopexy was an ascending testis (previously descended) in 85 (45%), parental delay in 41 (22%), late referral in 39 (20%), and iatrogenic cryptorchidism in 18 (9%). Ascended testes were more likely to have a history of being retractile (85% vs 30%), to have a patent processus vaginalis (78% vs 54%), and to be localized to the superficial inguinal area (87% vs 50%).

Conclusions

Primary care provider and parent education on the benefits of early orchiopexy is important, but in addition, ascending testes are much more common than previously thought. Patients with retractile testes should be followed regularly.     

The efficacy of ozone therapy in experimental caustic esophageal burn

Introduction

Ozone has been proposed as an antioxidant enzyme activator, immunomodulator and cellular metabolic activator. This study was designed to investigate the efficacy of ozone therapy in the prevention of esophageal damage and stricture formation developed after esophageal caustic injuries in the rat.

Materials and Methods

Forty-five rats were allocated into three groups; sham-operated, un-treatment and treatment groups. Caustic esophageal burn was created by instilling 15% NaOH in the distal esophagus. The rats were left untreated or treated with 1 mg/kg/day ozone intraperitoneally. All rats were sacrificed at 28 days. Efficacy of the treatment was assessed by measuring the stenosis index (SI) and histopathologic damage score, and biochemically by determining tissue hydroxyproline content (HP), superoxide dismutase (SOD), glutathione peroxidase (GPx), malondialdehyde (MDA) and protein carbonyl content (PCC) in esophageal homogenates.

Results

Whereas seven (47%) rats died in the un-treatment group, all rats in the sham-operated and the treatment group survived during the study. SI, the histopathologic damage score, was significantly lower in the ozone-therapy group than the un-treatment group. HP levels were significantly higher in the un-treatment group than the group treated with ozone. Caustic esophageal burn increased MDA and PCC levels and also decreased SOD and GPx enzyme activities. In contrast, ozone therapy decreased the elevated MDA and PCC levels and also increased the reduced SOD and GPx enzyme activities.

Conclusion

Ozone has a preventive effect in the development of fibrosis by decreasing tissue damage and increasing the antioxidant enzyme activity in an experimental model of corrosive esophageal injury.     

Surgical treatment of postinfarction pseudoaneurysms of the left ventricle

BACKGROUND: Left ventricular pseudoaneurysm is a rare and frequently fatal complication of acute myocardial infarction. It occurs as a consequence of rupture of the ventricular free wall that gets confined by a portion of the pericardium. The purpose of this study was to present our surgical experience of postinfarction left ventricular pseudoaneurysms and to evaluate mid-term results. METHODS: The study population comprised five symptomatic patients diagnosed with left ventricular pseudoaneurysm and treated surgically in a short period of time. There were three males and two females. The mean age of the patients was 66.8 +/- 10.8 years. The diagnosis was made initially by echocardiography and subsequently confirmed by angiography. An additional cardiac magnetic resonance imaging study was performed in three patients. Surgical resection of the pseudoaneurysm was combined with an endoaneurysmorrhaphy procedure in all patients. Associated cardiac operations were performed in three patients. Definitive diagnosis of pseudoaneurysm was confirmed by histopathological evaluation of the excised wall in all patients. RESULTS: All patients survived the operation and were discharged to home care. The mean duration of hospital stay was 11.6 +/- 4.6 days. Patients were either in class I or II of New York Heart Association classification at discharge. All patients are still being followed after surgery with a mean follow-up period of 10.4 +/- 6.6 months with no further problems. CONCLUSION: Surgical repair is indicated in left ventricular pseudoaneurysm as it carries a high risk of rupture and sudden cardiac death. Surgical repair combined with an endoaneurysmorrhaphy procedure carries a low mortality risk and improves functional capacity.