Hashimoto’s thyroiditis with granulomas: A unifying immunological etiology?

Two cases of granulomatous inflammation of the thyroid gland associated with Hashimoto’s thyroiditis are presented. In neither case is there an obvious cause of granuloma formation, the only accompanying abnormality being rheumatoid arthritis in one of the patients. Autoimmune thyroid disease has been reported in association with sarcoidosis as well as rheumatoid arthritis, diseases in which cellular immunity is activated. Immune mechanisms alone are capable of initiating and amplifying granulomatous inflammation. In this report, we suggest that the granulomas in both cases may have their origin in immunological malfunction, the same immunological malfunction responsible for Hashimoto’s thyroiditis.     

Induction of Labour for Prevention of Stillbirth from Rh Hemolytic Disease

The fate of 80 infants delivered after induction of labour in 72 Rh-sensitized mothers was studied to determine whether the stillbirth rate could be reduced. Labour was induced at 32 to 39 weeks of gestation; the criteria for induction were based on the history of previously affected infants, and a maternal Rh-antibody titre of 1/40 or greater, using an indirect antiglobulin technique. Nine mothers were delivered by Cesarean section. It was estimated that 26 infants were so severely affected as to be unlikely to have survived to term. However, only seven died, and one was stillborn. Two of these would normally have survived, one being Rh-negative. These two cases demonstrated the main danger in this method of management. There was a probable saving of 18 infants. In 22 mothers there was no history of previous delivery of an affected infant; in all 22 the infants survived, though six probably would not have survived to term. In 15 pregnancies in which the mothers had had a previous stillbirth, 12 infants survived. Sixty-seven infants required a total of 116 exchange transfusions. Despite the hazards it is concluded that early induction has an important place in management of Rh hemolytic disease.     

Echogenicity of prostate cancer correlated with histologic grade and stromal fibrosis: endorectal US studies

In this study an attempt was made to clarify some of the causes of the apparent differences in appearance on ultrasound (US) images of prostate cancer. These differences were correlated with histologic grade and the degree of stromal fibrosis present. Fifty-one cancers (diagnosed and evaluated by means of US-guided biopsy or evaluated by means of radical prostatectomy) were studied. There were 30 hypoechoic, ten echogenically mixed, six isoechoic, and five subtly hyperechoic cancers. The degree of stromal fibrosis was minimal in well-differentiated cancers and increased in poorly differentiated cancers. In addition, the more hypoechoic lesions were, in general, the better-differentiated cancers and had less fibrosis. There was a tendency for the isoechoic cancers and those with subtly hyperechoic areas to more often have poor cellular differentiation and a greater degree of stromal fibrosis, but considerable overlap among histologic types was seen.     

Management of ejaculatory duct obstruction: etiology, diagnosis, and treatment

Abnormalities of the distal ejaculatory ducts related to infertility have been well-documented. Although there are no specific findings associated with ejaculatory duct obstruction, several clinical findings are highly suggestive. A diagnosis of ejaculatory duct obstruction is suggested in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on TRUS. Other causes of infertility may be concomitantly present and need to be evaluated and treated. Trans urethral resection of ejaculatory ducts (TURED) has resulted in marked improvement in semen parameters, and pregnancies have been achieved. Proper patient selection and surgical experience are necessary to obtain optimal results. In case of testicular dysfunction, chances of success are minimal. Extended follow-up periods are needed after TURED to examine the long-term effects of this procedure. Better understanding of the anatomy and pathology of the ejaculatory ducts will continue to refine diagnostic and therapeutic procedures for this disorder.     

Impact of season and discharge weight on complications and growth of Kangaroo Mother Care treated low birthweight infants in Mozambique

This study aimed to determine the impact of season and weight at discharge on growth rate and complications in low birthweight infants treated with Kangaroo Mother Care (KMC) in Maputo, Mozambique. The study population included 246 infants of birthweight < 2000 g. Follow-up until 2400 g was obtained in 64%. There were no seasonal differences in weight gain and the risk of complications of infants treated with KMC in hospital. During the cold season after discharge, the risk of serious complications, including death, was higher (risk ratio 1.96; p = 0:02) and more readmissions occurred (risk ratio 2.77; p = 0:04). We postulate that after discharge mothers are unable to comply with the kangaroo position at all hours of the day and that exposure to low ambient temperatures may explain the more frequent occurrence of complications in the cold season. The weight at discharge did not affect complications or growth rate. We conclude that the current policy to discharge infants when having gained weight on 3 consecutive days, regardless of the actual weight, or whether the weight at birth has been regained, is adequate. In the cold season particularly, more efforts may be needed to ensure compliance with kangaroo position after discharge and to educate mothers on early signs of complications such as bronchopneumonia to encourage timely care seeking. With this method, low birthweight infants can grow adequately.