Brucellosis: a retrospective evaluation

One hundred and sixty-six presumed brucellosis patients were included in the study. These patients were classified as primary (91), relapse (18) and suspected (57) cases according to their clinical presentations, and serologic and microbiologic test results. Primary and relapse cases were evaluated retrospectively according to age, sex, residence, routes of transmission, clinical and laboratory findings, treatment regimens, duration of treatment, and relapse rates. Of the 109 primary and relapse patients, 57 were male and 52 female. The ages of the patients ranged between 16-75 (mean age 40.2). The percentages of the urban and rural residence of the patients were 41.3% and 58.7%, respectively. The most common mode of transmission was consumption of unpasteurized milk and milk products (67.9%). Malaise, fever and sweating were the most frequently observed symptoms (96.3%, 95.4%, 91.7%, respectively). The most common signs were fever (97.2%), splenomegaly (59.6%), and hepatomegaly (37.6%). The liver was the most frequently involved organ (21.1%). Almost all (99.1%) patients were serologically positive. However, the positivity rate of culture was low (15.6%). The most frequently preferred antimicrobial regimen was rifampin and doxycycline combination. The relapse rate was 8.3%. Brucellosis is still prevalent in Turkey as in many other countries in the Mediterranean basin. The clinical presentation of the disease may show regional variations. Patients with a history of occupational or nutritional contact with the bacterium and with a compatible clinical picture should be examined using appropriate diagnostic techniques before any attempt to prescribe an antimicrobial.     

Cortical activation associated with the experience of auditory hallucinations and perception of human speech in schizophrenia: a PET correlation study

A [H(2)(15)O] PET correlation analysis technique was employed to correlate brain activations associated with self-reports of auditory hallucinations in hallucinating patients (n=8) and perception of transient, random human speech in non-hallucinating (n=7) patients and normal control subjects (n=8). Perception of externally generated human speech amongst the non-hallucinating and normal control participants was associated with a consistent pattern of extensive bilateral auditory cortex activation (Brodmann areas 40/41/42/22). Hallucinating participants demonstrated a network of cortical activations including bilateral auditory cortex, left limbic regions, right medial frontal and right prefrontal regions. The observed pattern of activation is consistent with models of auditory hallucinations as mis-remembered episodic memories of speech.     

Cardiac abnormalities in end stage renal failure and anaemia

Thirteen anaemic children on dialysis were assessed to determine the incidence of cardiac changes in end stage renal failure. Nine children had an increased cardiothoracic ratio on radiography. The electrocardiogram was abnormal in every case but no child had left ventricular hypertrophy as assessed by voltage criteria. However, left ventricular hypertrophy, often gross, was found on echocardiography in 12 children and affected the interventricular septum disproportionately. Cardiac index was increased in 10 patients as a result of an increased left ventricular stroke volume rather than heart rate. Left ventricular hypertrophy was significantly greater in those on treatment for hypertension and in those with the highest cardiac index. Abnormal diastolic ventricular function was found in 6/11 children. Children with end stage renal failure have significant cardiac abnormalities that are likely to contribute to the high cardiovascular mortality in this group. Anaemia and hypertension, or its treatment, probably contribute to these changes. Voltage criteria on electrocardiogram are of no value in detecting left ventricular hypertrophy. Echocardiography must be performed, with the results corrected for age and surface area, in order to detect and follow these abnormalities.     

Urodynamic parameters in preoperative evaluation of patients with bladder tumours

Urodynamic evaluation was done in 28 patients with various staged bladder tumours. In 12 patients with superficial bladder tumours all urodynamic parameters were in normal range. Thirteen patients of 16 with invasive bladder tumours had low capacity of bladder and 5 of them also had involuntary contractions. In this study we suggest that urodynamic parameters in patients with bladder tumour became significantly abnormal when the first tumour invasion is seen at the muscular layer of the bladder (p<0.05); so compliance significantly decreased and the other pathological conditions were followed (p<0.05).     

Rotator cuff tear: clinical experience with sonographic detection

Between June 1986 and April 1988, 86 sonographic examinations of the shoulder were performed on patients suspected of having rotator cuff tears. Major sonographic diagnostic criteria included (a) a well-defined discontinuity usually visible as a hypoechoic focus within the cuff, (b) nonvisualization of the cuff and (c) an echogenic focus within the cuff. Seventy-five patients underwent both sonography and arthrography. Compared with arthrography alone, ultrasound examinations enabled detection of 92% of rotator cuff tears (24 of 26 tears), with a specificity of 84% and a negative predictive value of 95%. Correlation was obtained in 30 of these patients who underwent surgery for rotator cuff tear or other soft-tissue abnormality. In this group, the sensitivity of sonography for detection of a tear was 93%, with a specificity of 73%, while for arthrography sensitivity was 87% and specificity was 100%. These data indicate that sonography is a useful, noninvasive screening procedure for patients suspected of having rotator cuff injury.     

A case repot of Merkel cell carcinoma on chronic lymphocytic leukemia: differential diagnosis of coexisting lymphadenopathy and indications for early aggressive treatment

Background  

Chronic lymphocytic leukemia (CLL) is a monoclonal disorder, characterized by a progressive proliferation of functionally incompetent B lymphocytes. There is increased evidence of association between CLL and skin cancers, including the uncommon Merkel cell carcinoma (MCC).     

Prophylactic acetylcysteine usage for prevention of contrast nephropathy after coronary angiography

Radiographic contrast agents can cause acute decrease in renal functions. It is thought that anti-oxidant acetylcysteine can prevent contrast nephropathy. Fifty patients planned to undergo elective diagnostic coronary angiography with serum creatinine values above 1.3 mg/dL were included in the study. Acetylcysteine was given orally at a dose of 600 mg twice daily, on the day before and on the day of administration of contrast agent in the acetylcysteine group (n=25). Acetylcysteine was not given to the control group (n=25). Saline (0.9%) was given intravenously at a rate of 1 mL/kg/h for 12 hours before and 12 hours after administration of contrast agent. Contrast nephropathy was detected in 3 of 25 patients (12%) in the acetylcysteine group and 2 of 25 patients (8%) in the control group (P>0.05). Contrast nephropathy was developed in 2 of 4 patients (50%) with baseline serum creatinine concentrations above 2.5 mg/dL, whereas it was developed in only 3 of 46 patients (6.5%) with baseline serum creatinine concentrations below 2.5 mg/dL (P=0.04). It was detected that in patients planned to undergo elective diagnostic coronary angiography with renal dysfunction, oral acetylcysteine and hydration before the procedure was not more effective than hydration alone in the prevention of contrast nephropathy. High baseline serum creatinine values were detected as a risk factor for development of contrast nephropathy.