Subcapsular hepatic hematoma with right hepatic vein thrombosis: a complication of shock wave lithotripsy

Extracorporeal shock wave lithotripsy (ESWL) is a well-established, safe and effective therapeutic modality for surgical treatment of urolithiasis. Hematoma is a rare complication of ESWL and, when it occurs, typically involves the kidney. We report the case of a 71-year-old woman who developed severe, persistent abdominal pain after ESWL for a 9-mm stone at the ureteropelvic junction. Post-treatment CT scan demonstrated a 13 × 6–cm subcapsular hepatic hematoma. A follow-up CT scan showed expansion of the hematoma and development of hepatic vein thrombosis. This finding, along with persistent abdominal pain and rising liver transaminases, led to surgical intervention. The patient''s symptoms resolved and liver function returned to baseline following liver decompression.     

Cerebral venous sinus thrombosis in an adolescent with Ewing sarcoma

BACKGROUND: Although thromboembolic complications are common in adult patients with malignant diseases, cerebral venous sinus thrombosis has been rarely described in cancer afflicted pediatric and adolescent population. CASE HISTORY: A 16-year-old adolescent girl referred for complaints of pain and swelling on her left leg. On physical examination, a solid tibial mass was discovered. After the diagnosis of Ewing sarcoma with a tru-cut biopsy, chemotherapy protocol consisting of cisplatin, ifosfamide, adriamycine, and vincristine was started. During the first course of the treatment, the patient expressed headache, diplopia, and ptosis. Contrast-enhanced magnetic resonance (MR) images and MR angiography showed superior sagittal and transverse sinus thromboses. After anticoagulant therapy, the thromboses disappeared within 1.5 months. She received her chemotherapy protocol with the anticoagulant prophylaxis. After a follow-up period of 12 months, she is still in a good neurological recovery without any sequel. CONCLUSION: Children and adolescents with cancer should be monitored closely for thrombotic complications. We discuss this uncommon case to draw attention to the importance of early diagnosis and adequate treatment of intracranial thrombosis in childhood cancer, and we review the relevant literature.     

Magnetic Resonance Spectroscopy of the Thalamus in Essential Tremor Patients

BACKGROUND AND PURPOSE: Although essential tremor (ET) is one of the most common movement disorders, its pathogenesis remains obscure. The ventral intermediate nucleus of the thalamus (VIM nucleus) is suggested to play an important role in the occurrence of disease. In this study, the authors investigated the presence of biochemical or metabolic alterations in the thalamus of patients with ET using magnetic resonance (MR) spectroscopy. METHODS: The study group included 14 patients with ET who suffered from tremor predominantly in their right arm and 9 healthy controls. All patients and controls were right handed. Following conventional cranial MR imaging, single voxel proton MR spectroscopy of the thalamus involving the VIM nuclei was performed bilaterally in both the patients with ET and controls. Metabolite peaks of choline (Cho), creatine (Cr), and Nacetylaspartate (NAA) were obtained from each spectroscopic volume of interest. The right and left thalamic NAA/Cr and Cho/ Cr ratios were compared first within the patient group and then between the control and patient groups. The differences in age and spectroscopic data between groups were assessed using the Mann-Whitney U test, whereas the comparison within groups between left thalamus and right thalamus was done by the Wilcoxon test. RESULTS: In patients with ET, the NAA/Cr ratio of the right thalamus was found to be significantly higher than the NAA/Cr ratio of the left thalamus (P= .02). However, NAA/Cr and Cho/Cr ratios were found to be similar (P> .05) when we compared the control and patient groups for the right thalamus and then the left thalamus. CONCLUSION: These data present preliminary evidence for metabolic alterations of the contralateral thalamus (namely, low NAA/Cr ratio) in ET patients with predominantly involved right arm. However, the series is small and further data are necessary to clear the subject adequately.     

Association of T102C polymorphism of the 5-HT2A receptor gene with pyschiatric status in fibromyalgia syndrome

Serotonin (5-HT) is a key neurotransmitter in the central nervous system. It is suggested that serotonergic dysfunction may be involved in the pathophysiology of fibromyalgia syndrome (FS). In this study, we aimed to investigate T102C polymorphism of the 5-HT2A receptor gene in FS. Fifty-eight patients with FS and 58 unrelated healthy volunteer controls were included in the study. In both groups, the C/C, C/T, and T/T genotypes of the 5-HT gene were represented in 31% (22.4% in controls), 50% (53.4%), and 19% (24.1%), respectively. The 5-HT2A receptor gene polymorphism results were not significantly different between patients and controls (chi squared test, P>0.05). There was a significant correlation between patients with the T/T genotype and the subgroup according to the SCL-90-R test, (analysis of variance, P<0.05). We also saw that patients with the T/T genotype had the lowest pain threshold. CONCLUSION. T102C polymorphism of the 5-HT2A receptor gene is not associated with the etiology of FS. Our results also indicate that the T/T genotype may be responsible for psychiatric symptoms of FS.     

The expression of MMP-2, MMP-7, MMP-9, and TIMP-1 in chronic rhinosinusitis and nasal polyposis

OBJECTIVES: To investigate the expression and clinical significance of MMP-2, MMP-7, MMP-9, and TIMP-1 in patients with nasal polyposis (NP) and chronic rhinosinusitis (CRS). STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: This study involved 54 patients. There were three groups: nasal polyposis group, chronic rhinosinusitis group, and control group. Specimens were collected during endoscopic sinus surgery. Each sample was immunohistochemically examined. RESULTS: Expression of MMP-2 was found significantly increased in NP, whereas MMP-7 expression was found significantly increased in CRS (P < 0.001). TIMP-1 was significantly high in control group compared to CRS and NP (P < 0.001 and P = 0.002, respectively). CONCLUSIONS: Different regulation type of activation of MMPs has been found in these two diseases. If MMP-2 expression is intense in the mucosa, then this ends with polyp formation; if MMP-7 expression is intense, it ends with CRS or stays as CRS.     

The sympathetic skin response habituation in sedentary subjects and sportsmen

The aim of the present study was to investigate the habituation rates of the sympathetic skin response (SSR) in sedentary subjects and trained sportsmen. A total of 52 voluntary male students (30 sedentary subjects and 22 trained sportsmen) participated in the experiment. SSR was recorded with the contralateral electrical stimulation of the ulnar nerve (of the upper extremities). In order to initiate the SSRs, 16 square-wave consecutive electrical shock stimuli were presented to each subject over the left ulnar nerve. In 52 subjects, 16 stimuli were applied at random time intervals (20-50 s). In sedentary subjects, the mean amplitude of the SSRs decreased from 4.83 +/- 0.36 mV at the first stimulus, to 0.80 +/- 0.12 mV at the 16th stimulus. In trained sportsmen, the mean amplitude of the SSRs decreased from 3.95 +/- 0.51 mV at the first stimulus, to 0.80 +/- 0.17 mV at the 16th stimulus. In the sedentary subjects, at the S1-S9 stimuli, the mean amplitudes of SSRs were higher than those of trained sportsmen. Depending upon these findings we can say that the trained sportsmen showed a more rapid habituation than sedentary subjects. In these processes, changes of amplitude and latency values reflect changes in amount of neuronal activation. Amplitude reflects the amount of neuronal activation, which is concerned with number of neuronal populations. Neuroplasticity, known as the habituation of the brain, is the adaptation of autonomic nervous system, which can be reflected by SSRs.     

An MPC‐based position controller for a tilt‐rotor tricopter VTOL UAV

This study presents a novel framework, namely, the fusion of a conventional controller and a linear model predictive controller, for the position control of a tilt‐rotor tricopter. While the conventional controller in the outer loop is responsible for the position control, the inner‐loop model predictive control–based controller handles the angular dynamics and vertical body velocity. Furthermore, a novel control allocation algorithm for the proposed controller is introduced. In addition, this study also covers mathematical modeling and trim analysis of the tilt‐rotor tricopter dynamics. An evaluation of the designed control system is accomplished with a nonlinear 6‐degree‐of‐freedom simulation model of the tilt‐rotor tricopter in which realistic actuator limitations are considered. The efficiency of the proposed control algorithm is elaborated for a trajectory tracking problem where basic surveillance operation is considered. The simulation results show that the proposed model predictive controller is able to provide a satisfactory trajectory tracking performance under the realistic actuator limits.     

Evaluation of the early hemodynamic changes in carotid arteries during ventricular and dual chamber pacing

In spite of a wide choice of pacemakers, there are some problems in making more rational clinical decisions for individual patients since mode selection and programming is usually performed on the basis of a clinical hunch. The aim of this study was to measure the differences in carotid flow in patients with a pacemaker programmed in the dual chamber and in the single chamber pacing modes. Sixty patients with implanted bipolar DDD pacemakers were enrolled in this study. Blood peak systolic velocity (PSV) and end-diastolic velocity (EDV), cross-sectional area, resistive index (RI), and pulsatility index (PI) were measured in the common (CCA), internal (ICA), and external (ECA) carotid arteries before pacemaker implantation and after dual chamber and ventricular pacing at 60 beats/min. PSVs in the left CCA (79.3 +/- 24.9 cm/s) and right CCA (84.1 +/- 18.7) were shown to significantly decrease after VVI pacing (60.1 +/- 16.6 and 62.1 +/- 20.0, respectively). There was also a similar significant decrease in PSV in the left and right ICAs and ECAs. Besides PSV, RI, and PI in the left and right CCAs, ICAs, and ECAs significantly decreased after VVI pacing. There was no similar decrease after DDD pacing. Cross-sectional area and flow volume in the CCA, ICA, and ECA were similar after DDD and VVI pacing and before pacemaker implantation suggesting that cardiac output was similar when the measurements were recorded. Carotid artery PSVs, pulsatility, and RIs were found to be significantly decreased during VVI pacing compared to baseline and DDD pacing. The greater incidence of adverse cerebral outcomes in patients with VVI rather than DDD pacing may be partly due to decreased carotid PSVs.