Massive splenic hydatid cyst

Hydatid disease can involve any organ of the body and a high suspicion of this disease is justified in endemic regions. A case of massive splenic hydatid cyst with hepatic hydatidosis presented with 5 years history of abdominal distension with discomfort is reported. Clinically she had massive splenomegaly with hepatomegaly. Laboratory and radiological findings were diagnostic of hydatid disease of the liver and spleen. Peroperatively huge (35 x 20 cm) splenic hydatid cyst with two liver cysts was seen. Splenectomy was performed and hepatic lesions were subjected to endocystectomy with capsulorrhaphy.     

Chylothorax and chyloascites complicating cirrhosis of liver

Chylothorax and chyloascites is the accumulation of chyle in pleural and peritoneal spaces and are rarely seen. This case report describes the occurrence and management in an old lady. However, she expired due to frank haematemesis and encephalopathy. Chylothorax/chyloascites are difficult to manage and associated with poor prognosis.     

Pseudotumor of urinary bladder

The case of an old male is presented who had postoperative spindle cell nodule of urinary bladder. This benign condition mimics a sarcoma. However, the treatment modalities and the outcome are entirely different. Inflammatory pseudotumor/PSCN and leiomyosarcoma of the bladder overlap in clinical and immunohistochemical findings but are histologically as well as clinically distinct, correlating with different natural histories. Inflammatory Pseudotumor/PSCN are benign, not prone to metastasize, and is outside the spectrum of low-grade inflammatory sarcoma of urinary bladder.     

Lingual thyroid as a cause of snoring and sleep apnea

Lingual thyroid is a rare developmental abnormality. We describe a case of lingual thyroid in a 28 years old female who presented with symptoms of heroic snoring and obstructive sleep apnea. She was treated with surgery and was advised a life long thyroid hormone replacement therapy.     

Anterior thigh pain after cementless total hip arthroplasty

We compared the incidence of anterior thigh pain retrospectively following primary uncemented total hip replacement in 70 patients (78 hips) with osteoarthritis. In one group (38 hips), an Endoplus porous-coated, canal-filling prosthesis was inserted through an anterolateral approach. In the other group (40 hips), a Furlong hydroxyapatite-coated prosthesis was inserted through a posterior approach. The latter prosthesis has a relatively longer femoral stem and does not achieve diaphyseal press-fit contact. Three patients in the Furlong group had anterior thigh pain, which eventually resolved in two patients. In the Endoplus group, two patients developed anterior thigh pain; in both cases, there was an underlying cause, which had to be treated. Idiopathic anterior thigh pain is more common in non-canal-filling prostheses. When anterior thigh pain is noticed in canal-filling prosthesis, a search for and treatment of the cause will cure the pain. The hydroxyapatite coating did not prevent thigh pain in the Furlong group.

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Résumé Nous avons comparé rétrospectivement la fréquence des douleurs antérieures de la cuisse après prothèse totale non cimentée chez 70 malades (78 hanches) avec coxarthrose Dans un groupe (38 hanches), la prothèse à revêtement poreux Endoplus a été implanté par un abord antérolatéral. Dans lautre groupe (40 hanches), la prothèse enduite dhydroxyapatite Furlong a été implantée par un abord postérieur. Cette deuxiéme prothèse a une tige fémorale relativement plus longue et na pas un contact press-fit diaphysaire Trois malades dans le groupe Furlong avaient des douleurs antérieures de la cuisse, qui ont disparues pour deux dentre eux. Dans le groupe Endoplus, deux malades ont développé ces douleurs, et, dans les deux cas, il y avait une cause sous-jacente qui a dû être traitée La douleur antérieure, idiopathique, de la cuisse est plus fréquente avec la prothèse non remplissante. Quand cette douleur est notée avec une prothèse remplissante , la recherche et le traitement de la cause la feront disparaître. Le revêtement dhydroxyapatite na pas empêché les douleurs de la cuisse dans le groupe Furlong.

     

A comparison of lipid and glycemic effects of pioglitazone and rosiglitazone in patients with type 2 diabetes and dyslipidemia

OBJECTIVE: Published reports suggest that pioglitazone and rosiglitazone have different effects on lipids in patients with type 2 diabetes. However, these previous studies were either retrospective chart reviews or clinical trials not rigorously controlled for concomitant glucose- and lipid-lowering therapies. This study examines the lipid and glycemic effects of pioglitazone and rosiglitazone. RESEARCH DESIGN AND METHODS: We enrolled subjects with a diagnosis of type 2 diabetes (treated with diet alone or oral monotherapy) and dyslipidemia (not treated with any lipid-lowering agents). After a 4-week placebo washout period, subjects randomly assigned to the pioglitazone arm (n = 400) were treated with 30 mg once daily for 12 weeks followed by 45 mg once daily for an additional 12 weeks, whereas subjects randomly assigned to rosiglitazone (n = 402) were treated with 4 mg once daily followed by 4 mg twice daily for the same intervals. RESULTS: Triglyceride levels were reduced by 51.9 +/- 7.8 mg/dl with pioglitazone, but were increased by 13.1 +/- 7.8 mg/dl with rosiglitazone (P < 0.001 between treatments). Additionally, the increase in HDL cholesterol was greater (5.2 +/- 0.5 vs. 2.4 +/- 0.5 mg/dl; P < 0.001) and the increase in LDL cholesterol was less (12.3 +/- 1.6 vs. 21.3 +/- 1.6 mg/dl; P < 0.001) for pioglitazone compared with rosiglitazone, respectively. LDL particle concentration was reduced with pioglitazone and increased with rosiglitazone (P < 0.001). LDL particle size increased more with pioglitazone (P = 0.005). CONCLUSIONS: Pioglitazone and rosiglitazone have significantly different effects on plasma lipids independent of glycemic control or concomitant lipid-lowering or other antihyperglycemic therapy. Pioglitazone compared with rosiglitazone is associated with significant improvements in triglycerides, HDL cholesterol, LDL particle concentration, and LDL particle size.     

Live three-dimensional transthoracic echocardiographic demonstration of septal perforator coronary artery-left ventricle fistulas following myectomy

We present an adult patient with hypertrophic cardiomyopathy status post septal myectomy in whom live three-dimensional transthoracic echocardiography (3D TTE) demonstrated two septal perforator coronary arteries opening directly into the left-ventricular outflow tract. Only one of these fistulas could be demonstrated by two-dimensional transthoracic echocardiography (2D TTE). Our case demonstrates the potential usefulness of 3D TTE as a supplement to 2D TTE in the assessment of septal coronary artery-left ventricle fistulas.     

A prospective, randomized comparison of the metabolic effects of pioglitazone or rosiglitazone in patients with type 2 diabetes who were previously treated with troglitazone

OBJECTIVE: To characterize potential differences in glycemic control, plasma lipid level, and weight in a cohort of patients previously treated with troglitazone (TROG) who were switched to either pioglitazone or rosiglitazone. RESEARCH DESIGN AND METHODS: After a 2-week washout from TROG, 186 patients were randomly assigned to receive either pioglitazone (PIO) or rosiglitazone (ROSI). Weight, HbA(1c), and fasting lipid profile were documented before discontinuing TROG and at 4 months after starting either pioglitazone or rosiglitazone. Secondarily, the effect of concurrent medications on study outcomes was assessed. RESULTS: A total of 127 patients completed follow-up: 67 individuals in the PIO group (32 women, 35 men) and 60 individuals in the ROSI group (33 women, 27 men). There were no significant differences in gender mix, age, weight, fasting lipid profile, or HbA(1c) between the ROSI and PIO groups. After 4 months of randomized treatment, no change in HbA(1c) from baseline between or within groups was noted. Both groups experienced an equal and significant increase in weight from baseline of approximately 2.0 kg. Thiazolidinedione and HMG-CoA reductase inhibitor therapy had significant and independent effects on lipid profile (P < 0.005). Significant improvements in lipid profile were noted in the PIO group (P < 0.01), whereas none were detected with conversion to ROSI. Specifically, the PIO group experienced an average decrease in total cholesterol of approximately 20 mg/dl. CONCLUSIONS: Differing effects on lipid profile were apparent after random conversion from TROG to either PIO or ROSI, despite similar weight increase and glycemic control. The clinical significance of these differences remains to be determined, and further comparative research is warranted.     

Radiolabeling,quality control,and biological characterization of 177Lu‐labeled kanamycin

Kanamycin is an antibiotic, isolated from Streptomyces kanamyceticus, which is used to treat serious bacterial infections. The fact that the present radioligand ^99mTc‐kanamycin used for diagnosis is short‐lived, raised a need to label and study kanamycin with one of the most important beta (β) radiation emitting isotope ¹⁷⁷Lu. Labeling yield of ¹⁷⁷Lu‐kanamycin was confirmed by different chromatography techniques such as paper chromatography, TLC, HPLC. Several experiments were performed to optimize labeling with changing reaction conditions such as pH, temperature, amount of ligand, and reaction time. In vitro stability analysis was performed incubation with human serum. Electrophoresis analysis was also conducted to determine the charge on ¹⁷⁷Lu‐kanamycin. The biodistribution and scintigraphy were performed in normal mice and rabbit, respectively, at different time intervals of postinjection. ¹⁷⁷Lu‐kanamycin was prepared with very high yield (~100%), with excellent stability in vivo and in vitro (>99% 6 hr postprep.), at pH 7. Maximum labeling was achieved at less reaction time (15 min), with maximum conjugation of the ligand (12.5 mg) with ¹⁷⁷Lu. Electrophoresis analysis showed net neutral charge. The radioligand showed rapid clearance from body in biodistribution and scintigraphy studies. The preparation ¹⁷⁷Lu‐kanamycin could be used as a radio‐pharmaceutical for infection imaging purpose, especially when transporting the radioligand to long‐range distances.