Myoglobin-associated acute kidney injury in the setting of ciprofloxacin administration

Myoglobin-associated kidney injury typically is seen in severe rhabdomyolysis. Nontraumatic rhabdomyolysis may be triggered by direct drug toxicity, drug-drug interactions, and individual patient myopathic risk factors. We present a case of myoglobin-associated kidney failure in the setting of repeated ciprofloxacin administration in a lung transplant patient. Kidney biopsy was critical to establishing the diagnosis and avoiding future exposure.     

An Unusual Cause of Refractive Chronic Bilateral Leg Ulceration

Background

Ulceration of the lower extremities is a common disorder that can be very painful. It occurs most frequently in the elderly population as a result of venous hypertension. We report an unusual case of a 32-year-old man with an 11-year history of extensive, painful, bilateral leg ulcers resistant to conventional treatment necessitating above-knee amputation of the left leg. Eventually, the patient was treated with prednisone, which led to almost complete healing of the ulcers of the right leg.

Objective

The objective of this report is to discuss a rare cause of chronic bilateral leg ulceration.

Methods

Detailed histopathologic examination showed a complex pattern of overlapping features of several specific dermatologic conditions, including necrobiosis lipoidica (NL), necrobiotic xanthogranuloma (NXG), and the destructive form of granuloma annulare (GA).

Conclusion

The characteristics of our patient suggest a variant of a cutaneous necrobiotic disorder that has not been previously reported. When clinicians are confronted with recalcitrant ulcerations in the lower extremity, this group of disorders should be considered in the differential diagnosis.

     

Endoscopic management of limited attic cholesteatoma

OBJECTIVES: Microscopic postauricular tympanomastoidectomy provides a limited exposure to the attic, especially anteriorly. In contrast, the endoscope offers wide transcanal access to the attic, allowing for complete removal of limited attic disease, possibly without interrupting the ossicular chain. This report evaluates 8 years of experience with transcanal endoscopic management of limited attic cholesteatoma. STUDY DESIGN: Case series. METHODS: Seventy-three ears with limited attic cholesteatoma underwent endoscopic transcanal tympanotomy and extended atticotomy to access and completely remove the sac. Disease was dissected off the tegmen, the medial and lateral attic walls, and the ossicles. Appropriate ossicular reconstruction was performed. The defect was reconstructed with a composite tragal graft. RESULTS: A transcanal endoscopic approach was adequate for removal of disease in all cases. There were no iatrogenic facial nerve injuries. Bone thresholds were stable. Disease was dissected off the head of the malleus and the body of incus with preservation of both in 24 ears. Mean follow-up was 43 months. Five ears required revision for recurrent disease, and eight were revised for failed ossicular reconstruction or persistent perforation. Moderate to severe retraction in other areas of the tympanic membrane was evident in 28 cases; none of these required further intervention. CONCLUSION: An endoscopic technique allows transcanal, minimally invasive, eradication of limited attic cholesteatoma. Preservation of the ossicles coupled with complete removal of disease is more likely with the endoscope.     

Vestibular Schwannoma Growth: The Continuing Controversy

Objective To investigate the growth of vestibular schwannoma (VS) in a series of 123 patients with 127 tumors allocated to the “wait and scan” group in the period 1973–1999. Study Design Retrospective review of prospectively registered data on all patients with VSIÈ from the entire country who were allocated to the wait and scan group. Method Clinical charts, audiometric data, and neuroradiological images were reviewed and tabulated for age, hearing level expressed as speech reception threshold (SRT) and speech discrimination score (SDS), maximum extracanalicular tumor extension, and possible changes in tumor diameter. The material was updated three times (in June 1993, June 1996, and June 1999). Via the Danish national register, data on whether the included patients were alive or dead were collected in 1999. Results The tumor growth, growth rate, and growth patterns were calculated in three periods 1973 to 1993 (mean observation period, 3.4 y), 1973 to 1996 (mean observation period, 3.8 y), and from 1973 to 1999 (mean observation period, 4.2 y). By termination of the first period, 94 tumors (74%) exhibited measurable growth, 23 tumors (18%) no measurable growth, and 10 tumors (8%) revealed negative growth. By the end of the extended observation period, tumor growth was observed in 104 tumors (82%), no tumor growth in 15 tumors (12%), and negative growth in 8 tumors (6%). Subsequent to the third observation period, growth was observed in 108 tumors (85%), no growth in 11 tumors (9%) and negative growth in 8 tumors (6%). However, the results may also be interpreted in another way: 52 patients (42%) were alive at the time of writing, tumor growth did not demand any intervention, 23 patients (19%) died as a result of non–tumor‐related causes, and 35 patients (28%) were previously treated and alive by the termination of the third observation period. Conclusion Depending on the observation period, three sets of growth results were obtained. The long observation period, updating and re‐updating the results, gave us the opportunity for a de novo interpretation of the results and the long‐term consequences of the wait and scan policy. Combined with other factors, the achieved results should be considered when timing of surgery is to be decided.