Staged male urethroplasty transferring megalourethra tissue as free graft dorsal inlay to proximal urethral atresia in VACTERL association

Megalourethra is a rare spectrum of urologic malformations of penile corporal structures frequently associated with multiple congenital anomalies, such as prune belly syndrome or vertebral, anorectal, cardiac, trachea-esophageal, renal, and limb (VACTERL association) defects. A 6-year-old boy with VACTERL association and proximal urethral atresia with distal fusiform megalourethra underwent staged reconstruction, including appendicovesicostomy, perineal urethrostomy, and first-stage urethroplasty with a dorsal inlay free graft of megalourethra tissue to the proximal urethral atretic region, followed by second-stage urethroplasty. At 2.6 years of follow-up, he was continent, voids per urethra without postvoid residual urine volume, and no longer performs clean intermittent catheterization by way of the appendicovesicostomy.     

Computer Based Synchronization Analysis on Sleep EEG in Insomnia

Inter-hemispheric sleep EEG coherence is studied in 10 subjects with psycho physiological insomnia, in 10 with paradoxical insomnia, and in 10 matched controls through different states of the sleep/wakefulness cycle. Inter hemispheric EEG coherence between central electrode pairs are compared to each other within these groups. A linear measure called as Coherence Function (CF) and a nonlinear measure called as Mutual Information (MI) are performed by using the Information Theory Toolbox in the present sleep EEG synchronization study. Regarding as tests, for all-night EEG recordings of participants, both measures indicate higher degree of EEG coherence for insomnia than for controls. The results further validate inter-hemispheric CF as a sign of activity in insomnia where the EEG series from stage2, REM sleep and the eyes closed waking state. In particular, the CF is found to be more useful tool than the MI for detection of insomnia when the power spectral density estimations of sleep stages are provided by the Burg Method. In conclusion, the CF provides insights into functional connectivity of brain regions during sleep. Since the CF has a characteristic shape for sleep states, it can be proposed to identify the degree of EEG complexity depending on sleep disorders.     

Purtscher's Retinopathy: A Case Report

A 22-year-old male patient who had multiple upper extremity fractures and head trauma secondary to motorcycle accident was referred to our clinic a week after trauma for bilateral visual loss. Patient underwent a detailed ophthalmological examination including fundus fluorescein angiography, and he was diagnosed as Purtscher's retinopathy (PR). Visual acuity at baseline was counting fingers at 20 cm OD, and 1 meter OS. Patient received pulse steroid for 3 days which is followed by oral steroid with decreasing dosage for 11 days. Visual acuity at last control visit (5 months after trauma) was 0.1 OD, and 1.0 OS. Improvement in vision in our case may be spontaneous or secondary to steroid therapy. Since no proven effective treatment is currently available for PR, we believe that pulse steroid should be a potential option in these cases.     

Effects of intraoperative sponge mitomycin C and 5-fluorouracil on scar formation following strabismus surgery in rabbits

purpose?To investigate the influence of 5-fluorouracil (5-FU) and mitomycin C (MMC) on the postoperative adhesions following strabismus surgery in rabbits. methods?Twenty-one New Zealand white rabbits were used in this prospective, masked, controlled trial. Both eyes of 20 animals underwent 3-mm recession of the superior rectus muscle (SRM). In group I (10 animals), one eye of each animal received topical application of MMC (0.2?mg/ml) for 5 minutes and the other eye (control eye) was treated with balanced salt solution (BSS) using an intraoperative sponge. In group II (10 animals), a randomly chosen eye of each animal was treated with 5-FU soaked sponges (50?mg/ml) for 5 minutes and the fellow eye (control eye) with BSS. Two eyes of a rabbit were included as unoperated controls. Four weeks after the surgery, conjunctival vascularity and postoperative adhesions between the SRM Tenon's capsule (TC) and SRM sclera (scl) were assessed. Additionally, eyes were enucleated and evaluated histopathologically for evidence of scarring, granuloma formation, and muscle tissue changes under a light microscope. results?MMC-treated eyes had a higher rate of avascular conjunctiva compared to both controls and 5-FU-treated eyes. Mean adhesion scores, particularly between the SRM-scl, were lower in eyes treated with antiproliferative agents compared to controls. The difference was statistically significant in MMC-treated eyes for the adhesions between SRM-scl (p = 0.03). Histopathological examination revealed less scarring and granuloma formation in MMC- and 5-FU-treated eyes compared to their control eyes. conclusions?MMC, and to a lesser extent 5-FU, are shown to be effective in reducing postoperative scarring following strabismus surgery in rabbits. It seems reasonable to suggest that antimetabolites should be used for cases having an increased risk of postoperative adhesions.     

Prognostic Value of Epithelial Growth Factor Receptor,Vascular Endothelial Growth Factor,E-Cadherin,and p120 Catenin in Resected Non-Small Cell Lung Carcinoma

IntroductionSeveral markers have been investigated to predict the prognosis of lung cancer. In the present study, the prognostic values of epithelial growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), E-cadherin, and p120 catenin expression were investigated by immunohistochemistry in patients with a surgically resected non-small cell lung carcinoma (NSCLC).Patients and methodEGFR, VEGF, E-cadherin, and p120 catenin expression were prospectively determined in resected specimens from patients with NSCLC who had undergone surgery between 2003 and 2007. Patients’ and disease-related general characteristics and survival rate were recorded.ResultsOne hundred seventeen patients with a mean age of 61.3 years were included in the study. After a mean follow-up of 27.5 months, the median survival was determined to be 44.0 months and the 5-year survival was 46.2%. The 5-year survival in negative and positive staining groups were as follows; 32% and 66.7% for EGFR (P=.02), 37.8%, and 50.7% for VEGF (P=.5), 41% and 66% for E-cadherin (P=.19), and 46% and 50% for p120 catenin (P=.27). The differentiation, N status, stage, and EGFR staining were variables significantly affecting survival (P=.001, .006, .03, and .02, respectively). In multivariate Cox analysis, the EGFR staining level and N status were variables those significantly affecting survival (P=.021 and P=.010).ConclusionsWhile negative staining of EGFR was related with poor survival, staining of VEGF, E-cadherin, and p120 catenin were not related with survival in patients with resected NSCLC.     

Lipoprotein a levels in pediatric migraine

The purpose of this study was to examine the lipoprotein (a) [Lp(a)] levels in children with migraine to see a possible relationship between migraine and stroke via high Lp(a) levels. Plasma levels of Lp(a) were determined in 63 patients and age-matched control subjects. The mean age in the control group was 10.57 ± 3.63 years and 11.51 ± 3.19 years in the migraine patient group. The mean Lp(a) levels in control group were 10.36 ± 10.41 ng/mL and 17.09 ± 12.12 ng/mL in migraine group (P < 0.05). The median Lp(a) level in the control group was 49.38 ng/mL and was 77.62 ng/mL in the migraine group (P < 0.05). Twelve patients (19%) had Lp(a) levels of >30 ng/mL in the migraine group and 4 (6.3%) in the control group (P < 0.05). Several prothrombotic factors related to an increased risk of stroke have been studied in migraine patients. It has recently been reported that high Lp(a) concentrations represent a risk factor for migraine, thus establishing a novel plausible link between migraine and stroke. The current study suggests evidence of high Lp(a) concentrations in childhood migraine; perhaps a novel link exists between migraine and stroke.     

Serotonin syndrome due to duloxetine

Serotonin syndrome is a toxic condition due to serotoninergic hyperstimulation, which is caused mostly by serotonergic agents either in overdose or in combination. The diagnosis is purely clinical and poorly validated. We described a patient with tremor, mydriatic pupils, clonus, and ataxia after a single dose of duloxetine; on the dosage of admission. Duloxetine belongs to a large class of antidepressants called reuptake inhibitors. The case is presented to emphasize this possible toxicity due to increasing availability of serotonergic agents. It is a complex but easily preventable and recognizable condition. We believe this to be one of the rare reports of serotonin syndrome associated with duloxetine.