Splenic Abscess Due to Clostridium difficile and Pseudomonas Paucimobilis

Extraintestinal infection by Clostridium difficile is a rare entity. Herein we describe a 62-yr-old man with C. difficile bacteremia complicated by a splenic abscess. Of particular interest was the isolation of C. difficile and Pseudomonas paucimobilis from the splenic abscess. Prompt antibiotic therapy and splenectomy resulted in a favorable outcome. Although rare, these organisms should be considered in the differential diagnosis of a splenic abscess.     

Ten years of experience with pediatric neuroendoscopic third ventriculostomy: features and perioperative complications of 210 cases

Obstructive hydrocephalus remains a problem, and improvements in fiberoptic technology have promoted interest in neuroendoscopic ventriculostomy (NTV) as an alternative to standard cerebrospinal fluid shunts. The present study assessed 210 pediatric NTVs performed between 1994 and 2004 in patients aged 2 months to 10 years. Five children needed same-session ventriculoperitoneal shunting due to insufficient bypass of the obstruction. The other 205 procedures were technically successful, but 7 patients needed early-postoperative shunting and 10 required late shunting. During NTV, 86 (40.1%) of the patients developed arrhythmia. One patient arrested during balloon dilatation, but normal rhythm returned after deflation and epinephrine/atropine therapy, with no resultant morbidity. Twenty-six (10.2%) patients developed tachycardia (without hypertension) followed by bradycardia, and 6 children (2.8%) developed hypertension. In 1 case (0.5%), a branch of the basilar artery ruptured during fenestration and the hemorrhage was controlled after craniotomy. In 5 cases, mild venous bleeding was controlled by irrigation. The early complications included transient ocular divergence (n = 1), anisocoria (n = 2), and hyponatremia (n = 5). Five children were diagnosed with temporary diabetes insipidus in the late-postoperative period. The neuroendoscopic approach is considered safe for treating hydrocephalus in children, but complications can be severe or lethal and the anesthesiologist must respond accordingly.     

Acute leukoencephalitis in infant treated by high-dose corticosteroid. A case report

The authors report a case of acute post infectious leukoencephalitis observed in a tow-years and a half children admitted to our hospital for fiver with suddent condition deterioration, obnibulation, coma and paralysis of the 6th and 7th cranial nerve. Cerebrospinal fluid study showed lymphocytosis with negative culture. Head magnetic resonance imaging demonstrated diffuse high signals over the white matter on T2 weighted images so the diagnosis was confirmed. High dose corticosteroid therapy was effective.     

The incidence of accessory navicular bone types in Turkish subjects

Accessory ossicles are the skeletal variations of the ankle and foot that can cause painful syndromes. The accessory navicular bone is one of the most common accessory ossicle of the foot (4–21%) and is also known as os tibiale, os tibiale externum and os naviculare secundarium. This bone can be adjacent to the posteromedial tuberosity of the navicular bone or can be separated and may cause various diseases in the foot and mimic fractures of foot bones. The aim of this study was to document a detailed investigation of incidence and types of accessory navicular bones of Turkish subjects according to sex in both extremities. The accessory navicular bone was detected (11%) via the posterior–anterior radiographs of 650 subjects in the radiological examination. The incidences of accessory navicular bones were identified as 6.1–4.9% in female and male participants. Accessory navicular bones were classified into three groups as Type I, Type II and Type III and the incidences of these bones were determined as 3.3, 3.1, 4.6%, respectively. Each group was also divided into subgroups. The incidences of the subgroups are as Type Ia 0.6%, Type Ib 1.5%, Type Ic 1.2%, Type IIA/a 0.8%, Type IIA/b 0.4%, Type IIA/c 0%, Type IIB/a 1.1%, IIB/b 0.3%, IIB/c 0.5%, Type IIIa 1.5%, Type IIIb 1.4%, Type IIIc 1.7%. Finally, the types of accessory navicular bones were discussed and the imaging modalities for diagnosis were presented.     

Asymmetric dimethylarginine and nitric oxide levels as signs of endothelial dysfunction in Behcet's disease

Behcet's disease (BD) has been known for many years, yet the etiology of the systemic vasculitis remains unknown. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide (NO) synthase. ADMA is involved in endothelial dysfunction in various vascular diseases and its level in BD is unclear. This study was performed to evaluate the relationship between ADMA and NO levels in plasma of patients with BD. There were 3 groups of 30 subjects: (a) controls, (b) BD patients with mucocutaneous involvement, and (c) BD patients with vascular involvement. Plasma NO levels were assayed by spectrophotometry and plasma ADMA levels were assayed by an ELISA test. Plasma ADMA levels were higher in both groups of BD patients than in the controls; the ADMA levels were higher in the BD patients with vascular involvement than in the mucocutaneous group. Plasma NO levels were lower in both groups of BD patients than in controls; plasma NO levels were lower in the BD patients with vascular involvement than in mucocutaneous group. In the combined groups of 60 BD patients, there was significant inverse correlation between the plasma concentrations of ADMA and NO (r = -0.570, p <0.001). Plasma lipid profiles did not differ significantly between the BD patients and the controls. These results are evidence for increased plasma ADMA levels and decreased plasma NO levels as risk factors for cardiovascular events in BD patients. Inhibition of NO synthesis by ADMA may contribute to vascular involvement in BD.     

Pseudotumor of the Tracheal-Laryngeal Junction with Unusual Morphologic Features Caused by Rhodococcus equi Infection

Infectious pseudotumors are unusual proliferations of histiocytes in response to certain microbial organisms. Occasionally this process may involve large airways, producing a mass lesion that may cause respiratory obstruction. Infectious pseudotumors can be confused with malignancy in their radiologic appearance and clinical presentation. We present a case of an aggressive endotracheal pseudotumor associated with Rhodococcus equi infection in a patient with advanced HIV disease. Microscopically, the lesion was composed of sheets of epithelioid histiocytes with large, strongly eosinophilic intra-cytoplasmic granules and features of malakoplakia. In this report, we review the literature of these unusual lesions and compare them to cases of conventional malakoplakia involving the large airways. We also explore the pathogenetic mechanisms that may contribute to the distinctive histologic appearance of Rhodococcus-associated pseudotumors.