Chronic lower leg swelling caused by isolated popliteal venous entrapment

Isolated popliteal vein entrapment is a rare pathologic condition. Mimicking any venous pathology, a high degree of suspicion is mandatory for diagnosis. We describe a case of a 50-year-old woman, suffering from excessive swelling and heaviness of her left leg for more than 15 years. The ascending venography at functional positions of the feet demonstrated the entrapment. A rich collateral venous network appeared in the popliteal area at plantar foot's flexion. Surgical division of a wide soleus aponeurosis decompressed the vein. At the 2-year follow-up, the patient remains free of recurrence.     

Secular trends of antimicrobial resistance of blood isolates in a newly founded Greek hospital

Background  

Antimicrobial resistance is one of the most challenging issues in modern medicine.     

The significance of compliance for the success of antimicrobial prophylaxis in recurrent lower urinary tract infections: the Greek experience

In an attempt to define the most important driver responsible for recurrence of cystitis in women, 181 records were retrospectively analysed among 1010 consecutive references in a tertiary centre for lower urinary tract infections (UTIs). All 181 women had more than three episodes of cystitis per year; 129 were under continuous prophylaxis and 52 were under postcoital prophylaxis. Analysis revealed that the most important factor affecting successful outcome of chemoprophylaxis was the compliance of patients (odds ratio 0.074; P<0.0001). Among women treated for >or=6 months, the most effective regimen was nitrofurantoin, with a success rate of 96.8% compared with 82.8% for trimethoprim/sulphamethoxazole and 72.3% for norfloxacin (P=0.046 between agents). Failure of chemoprophylaxis was observed in 51 women in total; in 26 of them resistance to the administered agent had developed. Results of this retrospective study revealed that the most important driver leading to failure of prophylaxis for recurrent lower UTIs was the lack of compliance of women with their medication. Nitrofurantoin was the most potent among the administered agents.     

A case of primary isolated non-Hodgkin's lymphoma of the esophagus in an immunocompetent patient

Primary non-Hodgkin's lymphoma of the esophagus is a rare disease. A case of primary isolated non- Hodgkin's lymphoma of the esophagus in a 77-yearold man without acquired immunodeficiency syndrome is presented. We describe the clinical features and the imaging findings (barium swallow, endoscopic ultrasonography and CT) of a biopsy proven B-cell lymphoma with diffuse transmural involvement of the esophagus wall, which was discovered incidentally. We also briefly review the literature.     

Downgrading BIRADS 3 to BIRADS 2 category using a computer-aided microcalcification analysis and risk assessment system for early breast cancer

This paper explores the potential of a computer-aided diagnosis system to discriminate the real benign microcalcifications among a specific subset of 109 patients with BIRADS 3 mammograms who had undergone biopsy, thus making it possible to downgrade them to BIRADS 2 category. The system detected and quantified critical features of microcalcifications and classified them on a risk percentage scale for malignancy. The system successfully detected all cancers. Nevertheless, it suggested biopsy for 11/15 atypical lesions. Finally, the system characterized as definitely benign (BIRADS 2) 29/88 benign lesions, previously assigned to BIRADS 3, and thus achieved a reduction of 33% in unnecessary biopsies.     

A fast response mechanism for insulin storage in crystals may involve kink generation by association of 2D clusters

Crystals that are likely rhombohedral of Zn-insulin hexamers form in the islets of Langerhans in the pancreases of many mammals. The suggested functions of crystal formation is to protect the insulin from proteases and increase the degree of conversion of soluble proinsulin. To accomplish these ends, crystal growth should be fast and adaptable to rate fluctuations in the conversion reaction. Zn-insulin crystals grow layer by layer. Each layer spreads by the attachment of molecules to kinks located at the layers' edges, also called steps. The kinks are thought to be generated either by thermal fluctuations, as postulated by Gibbs, or by 1D nucleation of new crystalline rows. The kink density determines the rate at which steps advance, and these two kink-generation mechanisms lead to weak near-linear responses of the growth rate to concentration variations. We demonstrate for the crystallization of Zn-insulin a mechanism of kink generation whereby 2D clusters of several insulin molecules preformed on the terraces between steps associate to the steps. This mechanism results in several-fold-higher kink density, a faster rate of crystallization, and a high sensitivity of the kinetics to small increases of the solute concentration. If the found mechanism operates during insulin crystallization in vivo, it could be a part of the biological regulation of insulin production and function. For other crystallizing materials in biological and nonbiological systems, this mechanism provides an understanding of the often seen nonlinear acceleration of the kinetics.     

Two cases of infections due to multidrug-resistant Bacteroides fragilis group strains

Bacteroides fragilis group strains are still considered susceptible to most antimicrobial agents used for the treatment of infections caused by anaerobic organisms. We describe two cases of infections due to isolates simultaneously resistant to clindamycin, tetracycline, cefoxitin, piperacillin-tazobactam, and imipenem and, in one of the two cases, to metronidazole. Such infections, although still rare, do exist and tend to complicate treatment.