Percutaneous peritoneal drainage in isolated neonatal gastric perforation

A comment on the article by He et al, “Idiopathic neonatal pneumoperitoneum with favorable outcome: A case report and review”, published on World Journal of Gastroenterology that reported a case of idiopathic neonatal pneumoperitoneum, possibly due to gastric perforation, with a favorable outcome without surgical intervention.     

Reliability of diffusion weighted MR imaging in differentiating degenerative and infectious end plate changes

Background

The aim of the study was to investigate the value of diffusion weighted MR imaging in the diagnosis of Modic type 1 change, which may be confused with the acute infectious spondylodiscitis on conventional MR imaging.

Patients and methods

Twenty-seven patients with erosive intervertebral osteochondrosis, Modic type 1 and 18 patients with spondylodiscitis were included in this retrospective study. All images were acquired using on 1.5 Tesla MR units. Lumbar spinal MR imaging of 45 patients were retrieved from a digital database of a radiology record system and evaluated by one experienced radiologist. Patients with Modic type 1 change had CT slices obtained from the diseased disc space and the affected vertebrae.

Results

Bone marrow adjacent to the vertebral end plate in both Modic type 1 change and acute spondylodiscitis were hypointense on T1-weighted images. On T2-weighted images corresponding levels of vertebral end-plates showed hyperintense signal intensity in both group. All the patients with spondylodiscitis and Modic type 1 change were hyperintense and hypointense on diffusion-weighted MR images, respectively.

Conclusions

Our findings suggest that diffusion weighted MR imaging is an useful method in differentiating Modic type 1 changes from acute spondylodiscitis, both of which may mimic each other, either on clinical or conventional MRI findings.     

A neonate with homozygous protein C deficiency with a homozygous Arg178Trp mutation

Homozygous protein C deficiency affects approximately 1/400,000 to 1/1,000,000 live births. Homozygous protein C deficiency is associated with catastrophic and fatal purpura fulminans-like or thrombotic complications and disseminated intravascular coagulation. In the present patient, genetic study revealed Arg178Trp, a mutation found widely in European population; but this is the first case of homozygous Arg178Trp mutation who suffered from catastrophic purpura fulminans phenotype.     

Effect of salt loading on baroreflex sensitivity in reduced renal mass hypertension

Background: High dietary salt, as well as renal mass reduction, is known to decrease baroreflex sensitivity in rats. However, the effect of high salt intake on baroreflex sensitivity is unknown in reduced renal mass (RRM) hypertension; therefore, the aim of this study was to investigate the effects of salt loading on arterial baroreflex sensitivity and mean arterial pressure (MAP) in RRM hypertension.

Methods: Both RRM and sham-operated control (SO) rats were loaded with 0.25 or 0.5% NaCl for five weeks. Plasma Na⁺, K⁺, and creatinine levels were measured, and baroreflex sensitivity was evaluated before and after β₁ blockade. In addition, cardiac vagal tone and intrinsic heart rate (IHR) were measured. RESULTS: RRM decreased full baroreflex sensitivity of the tachycardic response under 0.5% NaCl loading and the parasympathetic bradycardic response under 0% NaCl loading. The NaCl loading did not affect the severity of RRM hypertension. Cardiac vagal tone and IHR decreased in RRM rats versus SO controls under all NaCl loading conditions. RRM decreased plasma K⁺ under 0% NaCl loading and increased plasma Na⁺ under 0.5% NaCl loading. High (0.5%) NaCl loading decreased IHR and increased plasma creatinine and left ventricular weight in RRM rats. CONCLUSIONS: RRM in combination with 0.5% NaCl loading led to a decrease in the sensitivity of full baroreflex and of the parasympathetic component of baroreflex. Changes in plasma Na⁺ and K⁺ levels, due to NaCl loading, may have contributed to the decrease in baroreflex sensitivities and IHR but had no effect upon MAP in RRM rats.     

Perfusion and diffusion MR imaging in enhancing malignant cerebral tumors

OBJECTIVE: Common contrast-enhancing malignant tumors of the brain are glioblastoma multiforme (GBMs), anaplastic astrocytomas (AAs), metastases, and lymphomas, all of which have sometimes similar conventional MRI findings. Our aim was to evaluate the role of perfusion MR imaging (PWI) and diffusion-weighted imaging (DWI) in the differentiation of these contrast-enhancing malignant cerebral tumors. MATERIALS AND METHODS: Forty-eight patients with contrast-enhancing and histologically proven brain tumors, 14 AAs, 17 GBMs, nine metastases, and eight lymphomas, were included in the study. All patients have undergone routine MR examination where DWI and PWI were performed in the same session. DWI was performed with b values of 0, 500, and 1000 mm(2)/s. Minimum ADC values (ADC(min)) of each tumor was later calculated from ADC map images. PWI was applied using dynamic susceptibility contrast technique and maximum relative cerebral blood volume (rCBV(max)) was calculated from each tumor, given in ratio with contralateral normal white matter. Comparisons of ADC(min) and rCBV(max) values with the histological types of the enhancing tumors were made with a one-way analysis of variance and Bonferroni test. A P value less than 0.05 indicated a statistically significant difference. RESULTS: The ADC(min) values (mean+/-S.D.) in GBMs, AAs, lymphomas, and metastases were 0.79+/-0.21 (x10(-3)mm(2)/s), 0.75+/-0.21 (x10(-3)mm(2)/s), 0.51+/-0.09 (x10(-3)mm(2)/s), and 0.68+/-0.11 (x10(-3)mm(2)/s), respectively. The difference in ADC(min) values were statistically significant between lymphomas and GBMs (P<0.05). It was also statistically significant between lymphomas and AAs (P<0.03). However, there were no differences between lymphomas and metastasis, and between GBMs, AAs, and metastasis. The rCBV(max) ratio (mean+/-S.D.) in GBMs were 6.33+/-2.03, whereas it was 3.66+/-1.79 in AAs, 2.33+/-0.68 in lymphomas, and 4.45+/-1.87 in metastases. These values were statistically different between GBMs and AAs (P<0.001), GBMs and lymphoma (P<0.0001). Although there seemed to be difference between GBMs and metastases, it was not statistically significant (P<0.083). CONCLUSION: Combination of DWI and PWI, with ADC(min) and rCBV(max) calculations, may aid routine MR imaging in the differentiation of common cerebral contrast-enhancing malignant tumors.     

Urinary tract injuries during advanced gynecologic laparoscopy

Urinary tract injuries are important complications of laparoscopic surgery. The intraoperative diagnosis may be delayed, resulting in severe clinical complications, such as fistulas, in the immediate and late postoperative periods. A review of 776 endoscopic procedures revealed 6 urinary tract injuries and postoperative complications during laparoscopy. We believe that surgical experience, intraoperative diagnosis, immediate repair of the lesion, and close follow-up are the main factors contributing to decreased morbidity associated with these injuries.