Vena cava superior syndrome due to sternal plasmacytoma in the course of systemic myeloma

Here we present a patient with multiple myeloma course. The first clinical manifestation was superior vena cava syndrome due to a huge sternal plasmocytoma. The patient was treated with a combination of high dose radiotherapy and autologous peripheral blood stem cell transplantation. We suggest careful evaluation of these patients with respect to aggressive therapy.     

Reversible sensorineural hearing loss in a girl with Kawasaki disease

Kawasaki disease is an acute, self-limited vasculitis of infants and children that is now the most common cause of acquired heart disease in the pediatric age group in the United States and Japan. This report presents a case of classic Kawasaki disease with reversible sensorineural hearing loss that was treated with steroid. In conclusion, Kawasaki disease caregivers must be aware of possible sensorineural hearing loss, which is reversible by early intervention and thus improves quality of life.     

Diaphragmatic mesothelial cyst in a child with Fanconi aplastic anemia

Fanconi aplastic anemia (FAA), an inherited form of bone marrow failure syndrome, is characterized by progressive bone marrow failure and high risk of developing a malignancy. One or more congenital malformations may be detected in at least 90% of the affected individuals. Despite many forms of congenital malformations in FAA, there are no reports of coexisting FAA and diaphragmatic mesothelial cyst. Here, we report a 7-year-old female patient with FAA is associated with diaphragmatic mesothelial cyst.     

Nanoparticle silver ion coatings inhibit biofilm formation on titanium implants

The formation of bacterial biofilm on the surface of implanted metal objects is a major clinical problem. The antibacterial and antifungal effect of silver ions has been long known, and seems to give silver the capability to inhibit biofilm formation. To test the effect of silver ions, 20 New Zealand rabbits had bacteria applied to a screw insertion site at the iliac crest, and were then randomly divided into two groups: Group I, which had silver-coated screws applied, and Group II, which had uncoated titanium screws. After the rabbits were sacrificed on day 28, we examined the screws, the bone adjacent to the screws, and the liver, kidneys, brain and corneas of both groups under transmission (TEM) and scanning electron microscopy (SEM). We also analysed microbiological samples from the screw holes. All silver-coated screws, but only 10% of uncoated titanium screws, were sterile. All tissue samples appeared ultrastructurally normal in both groups. Biofilm formation was inhibited on all silver-coated screws, but all uncoated screws developed a biofilm on their surfaces. Our findings suggest that nanoparticle silver ion-coated implants are as safe as uncoated titanium screws and that they can help prevent both biofilm formation and infection.     

Radiologically placed tunneled peritoneal catheter in palliation of malignant ascites

The purpose of this study was to evaluate retrospectively the safety and effectiveness of radiologically placed tunneled peritoneal catheter in palliation of malignant ascites.Between July 2005 and June 2009, 41 tunneled peritoneal catheters were placed under ultrasonographic and fluoroscopic guidance in 40 patients (mean age, 55 years; 22 women) who had symptomatic malignant ascites. No procedure related mortality was observed. Major complication occurred in one patient (2.5%) in the form of serious bacterial peritonitis that necessitated catheter removal. Minor complications such as minor bacterial peritonitis, catheter dislodgement, tunnel infection, and catheter blockage occurred in 11 patients (27.5%). The mean duration of survival after catheter placement was 11.8 weeks. All patients expired of their primary malignancies in the follow-up.Radiologically placed tunneled peritoneal catheter is safe and effective in palliation of symptomatic malignant ascites.     

Survivin, p53, and Ki-67 as predictors of histopathologic response in locally advanced rectal cancer treated with preoperative chemoradiotherapy

Purpose The ability to predict response to chemoradiotherapy before the treatment may allow protecting poorly responding patients from the side effects of neoadjuvant treatment. Several molecular markers have been proposed to radio and chemosensitivity of rectal cancer. In this study, from pre-irradiation tumor biopsies, a novel and promising candidate factor survivin, and p53 and Ki-67 were assessed as predictors of response to preoperative chemoradiotherapy. Materials and methods Expression of each marker was evaluated by immunohistochemistry on pretreatment biopsies from 37 patients having rectal cancer treated with preoperative chemoradiotherapy and curative surgery. Treatment response was assessed histopathologically in the resected surgical specimen. Results There was no correlation between expression of p53, Ki-67, and survivin with response to preoperative chemoradiotherapy and prognosis. Conclusions Our data suggest that these molecular markers are not helpful to identify patients who would have benefit from neoadjuvant treatment of rectal cancer. Further investigations are necessary to select patients for preoperative treatment based on analysis of the preoperative biopsies.     

Evaluation of insulin resistant diabetes mellitus in Alström syndrome: a long-term prospective follow-up of three siblings

Alstr?m syndrome is a rare cause of diabetes mellitus. We studied two generations of a Turkish family in whom four members were affected by Alstr?m syndrome. The natural course of the syndrome in three sisters was followed for 13 yr. The three sisters had short stature and truncal obesity, and developed complete blindness due to retinitis pigmentosa at 10, 5 and 13 yr of age. Two had sensorineural hearing loss and mild mental retardation, while the other developed diabetic ketoacidosis (DKA) at 14 yr and was treated with insulin from onset of diabetes. In the second case, diagnosis of diabetes was made by an OGTT at age 20 yr, and controlled with diet alone for 11 yr, then with a sulphonylurea for 2.5 yr, then with insulin. The third case developed acute hyperglycaemia at 20 yr, and required insulin from onset. Moreover, transitional features of impaired carbohydrate and fat metabolism (severe hyperinsulinaemia and insulin resistance progressing to islet beta cell failure, and hypertriglyceridaemia with fatty liver) were demonstrated, in accord with the literature. Previously unreported findings characteristic of nephro-uropathy with early-onset hypertension were also detected, and included in all cases proteinuria, glomerulopathy, and abnormal locations of the kidneys, narrowed uretero-renal junctions and dilated ureters.     

Comparison of femoral and carotid blood pressure during laparoscopy in piglets

PurposeThe impact of a capnoperitoneum on the known blood pressure (BP) difference of the upper and lower limb was studied in piglets.MethodsEleven German Landrace piglets (body weight, 4.3-7.4 kg; mean body weight, 6.2 kg) were studied. Arterial lines were placed in the right carotid and right femoral artery for pressure monitoring. Intraabdominal pressure levels were increased in steps of 6 mm Hg up to 24 mm Hg.ResultsWe found that elevated intraabdominal pressures up to 24 mm Hg did not change the preexisting systolic BP difference between the carotid and femoral arteries. Systolic femoral artery pressure constantly remained 5% higher than its carotid counterpart. In addition, mean and diastolic values were not affected.ConclusionsArterial BP measurements recorded at the legs of piglets when abdominal pressure is increased by up to 24 mm Hg can be used for intraoperative assessment of systemic arterial BP.