Paradox in the cubital tunnel syndrome—frequent involvement of left elbow: first report

Objective

Cubital tunnel syndrome (CuTS) is the second most common compression neuropathy in the arm, but the existence of a compressive cause has not been determined conclusively and the majority of the cases are idiopathic. In this paper, involvement sides of limbs of patients with cubital tunnel syndrome were studied.

Material and methods

Between October 2008 and December 2011, the clinical assessment of consecutive operated patients with cubital tunnel syndrome in Rize Education and Research Hospital were analysed. The diagnosis and severity of syndrome was based on electro-diagnostic study.

Results

This study included 57 consecutive patients with cubital tunnel syndrome (39 men, 18 women; mean age, 44,7 years; range, 23–79 years; mean age, 44,7 years; range, 23–79 years); 31 patients underwent surgical treatment. Involvement was on the right side in 18 and on the left in 39 patients. Severity scores and MCV were statistically significant between sides.

Conclusion

Profound involvement with cubital tunnel was found in left elbow. According to the finding of non-dominant elbow involvement in our study, the exact etiology and ideal management of cubital tunnel syndrome continues to be heavily debated.     

Reactive Hemophagocytic Lymphohistiocytosis After Hepatitis A Infection

Hemophagocytic lymphohistiocytosis (HLH) is a clinical condition which result in cytotoxic Tcell and antigen presenting cell overproduction and also their cytokines. Hepatitis A Virus associated HLH is very rare condition among other viruses. This condition is often difficult to diagnose, so treatment is often delayed. Here we present a case of adolescent boy with secondary virus associated HLH diagnosis with Hepatitis A infection and successfull treatment by short course of intravenous immunoglobulin and steroid.     

Giant rhinophyma: Excision with coblation assisted surgery

An 83-year-old man presented with an unusually severe case of rhinophyma. Giant rhinopyhma is very rare in literature. The giant lesion was widely excised using sharp surgical incision and coblation assisted surgery. Using direct coblation to the nasal dorsum may cause edema in the surrounding tissue. There was minimal edema in surrounding tissue using this technique. A full thickness-skin graft was applied after excision. Cosmetic and functional postoperative results were satisfactory.KEY WORDS: Coblation, giant, rhinophyma     

Transient nephrogenic diabetes insipidus caused by fetal exposure to haloperidol

Haloperidol is commonly used in the treatment of psychiatric disorders. Data from animal experiments indicate haloperidol is not teratogenic, but is embryotoxic in high doses. For the first time, we report a neonate with transient nephrogenic diabetes insipidus (DI) caused by fetal exposure to haloperidol. The magnitude of risk associated with the use of haloperidol during pregnancy appears to be small, but nephrogenic DI secondary to haloperidol is a serious condition with the risk of hypernatremic dehydration. Haloperidol can have adverse effects on the fetus and newborn infant, that’s why one should prevent the use of haloperidol during pregnancy and lactation.     

The efficiency of Gd‐EOB‐DTPA‐enhanced magnetic resonance cholangiography in living donor liver transplantation: a preliminary study

The aim of this study was to evaluate utility of gadoxetic acid disodium (Gd‐EOB‐DTPA)‐enhanced magnetic resonance cholangiography (MRC) for the detection of biliary complications after living donor liver transplantation (LDLT). A total of 18 patients with suspected biliary complications underwent MRC. T2‐weighted MRC and contrast‐enhanced MRC (CE‐MRC) were used to identify the biliary complications. MRC included routine breath‐hold T2‐weighted MRC using half‐Fourier acquisition single‐shot turbo spin‐echo (HASTE) sequences and Gd‐EOB‐DTPA‐enhanced MRC T1‐weighted volumetric interpolated breath‐hold examination (VIBE) sequences. Before confirming the biliary complications, one observer reviewed the MRC images and the CE‐MRC images separately. The verification procedures and MRC findings were compared, and the sensitivity, specificity, and accuracy of both techniques were calculated for the identification of biliary complications. The observer found six of seven biliary complications using CE‐MRC. The sensitivity was 85.7% and the accuracy was 94.4%. Using MRC alone, sensitivity was 57.1% and accuracy was 55.5%. The accuracy of Gd‐EOB‐DTPA‐enhanced MRC was superior to MRC in locating biliary leaks (p < 0.05). The usage of Gd‐EOB‐DTPA‐enhanced MRC yields information that complements the MRC findings that improve the identification of biliary complications. We recommend the use of MRC in addition to Gd‐EOB‐DTPA‐enhanced MRC to increase the preoperative accuracy when assessing the biliary complications after LDLT.     

Prolonged QT Dispersion in the Infants of Diabetic Mothers

Myocardial hypertrophy and cardiac dysfunction frequently occur in newborns of diabetic mothers. The authors hypothesized that wall hypertrophy or disproportionate left ventricular wall thickness in newborns of diabetic mothers may affect both QT and QTc dispersion. This study aimed to assess whether left ventricular hypertrophy affects the QT variables of infants born to diabetic mothers. This prospective cross-sectional study was conducted with 47 consecutively selected neonates of gestational diabetic mothers and 30 healthy neonates born to healthy mothers. All the subjects were evaluated during the neonatal period. Electrocardiography with echocardiography was performed for the patients and the control subjects. The newborns of the diabetic mothers were classified according to septal thickness as group 1 (16 newborns with septal hypertrophy) or group 2 (31 newborns without septal hypertrophy). The study group consisted of three cohorts: groups 1, 2, and 3 (control group). Both QT and QTc dispersion were computed from a randomly selected beat as well as from an average beat derived from 12 beats included in a 10-s electrocardiography. A total of 16 infants (34 %) had a septal thickness of 6 mm or greater. The left ventricular end-systolic diameter in group 1 was smaller (p = 0.0029) than in groups 2 and 3 (p = 0.003). The interventricular septal thickness at end diastole (IVSTd) and the left ventricular posterior wall thickness at end diastole in group 1 were higher than in of groups 2 and 3. The QT and QTc dispersion intervals were longer in group 1 than in groups 2 and 3 (p < 0.001), and a highly significant positive correlation was detected between IVSTd and QT dispersion (r = 0.514, p = 0.042). Elevated QT and QTc dispersions may be risk factors for the development of arrhythmias in newborns of diabetic mothers. These patients may critically need systematic cardiac screening.