The Remission of Post-Transplant Nephrotic Syndrome Clinicopathologic Characterization

Among 67 renal transplant recipients with nephrotic syndrome (NS), nine episodes were reversible in eight patients. Biopsies showed minimal-change disease, focal segmental membranous glomerulonephritis and acute glomerulitis, IgA nephropathy and acute glomerulitis or thrombotic microangiopathy, and chronic transplant nephropathy with or without acute glomerulitis. NS developed 1-4 months post transplant in the four patients with minimal-change disease, but later (33-151 months) in the others. At onset, serum creatinine was normal or elevated. Treatment included calcium-channel blockers, angiotensin-converting enzyme inhibitors, or both, together with routine antirejection therapy. Remission was achieved 4-12 months after onset, when renal function remained normal in four, improved in four, and worsened in one. At last follow-up, six patients still had remission and functional grafts. One lost graft to chronic transplant nephropathy while NS remained in remission. In the remaining patient, proteinuria, which was due to chronic transplant glomerulopathy unrelated to the initial minimal-change disease-associated NS, recurred 50 months post transplant. Remission of post-transplant NS is possible. It is often associated with minimal-change diseases and less frequently with other glomerular lesions, including acute glomerulitis. Reversible post-transplant NS does not have an adverse effect on the renal allografts.     

Heterochromia iridis and Homer's syndrome due to paravertebral neurilemmoma

A case of heterochromia iridis and Horner's syndrome is reported in a 7-year old girl with paravertebral neurilemmoma. These clinical findings can be useful in the early diagnosis of mediastinal tumors in the paravertebral axis. While typically associated with neuroblastoma, these findings can be due to tumors which are inately benign — in this case neurilemmoma. The mechanism for heterochromia is briefly discussed.     

Sertoli-Leydig cell tumor of the ovary

Sertoli-Leidig cell tumor of the ovary is a rare tumor. It accounts for 0.5 - 1% of all ovarian tumors. Sertoli-Leidig cell tumors are commonly benign and they occur in young women who desire further childrearing. Although, the treatment must be as conservative as possible. For the malign Sertoli-Leidig cell tumor, radical treatment is required. The aim of this work is the analysis of clinical, para-clinical and therapeutic aspects of these tumors.     

The Place of Vacuum Extraction in Prolapsed Pulsating Cord

Summary: Sixty-three consecutive cases of prolapsed pulsating cord managed by vacuum extraction and 52 others managed by Caesarean section are reviewed. Statistical comparison showed that there was no significant difference between both groups as regards the number of depressed babies at birth, fetal complications or fetal loss (P > 0.05). Postoperative maternal complications were more significant with Caesarean sections (P < 0.001). The vacuum extractor appears to offer an alternative to Caesarean section in selected cases of prolapsed pulsating cord. Satisfactory maternal and fetal results depend on adequate funic decompression, proper selection of cases, rapid interference and skill in vacuum extraction. When speed is observed, the instrument can be applied within 5 minutes of diagnosis and in most cases delivery achieved with 10 minutes traction.     

Anterior cruciate ligament reconstruction: Magnetic resonance imaging and factors influencing outcome

Purpose

This study was conducted to determine the magnetic resonance imaging (MRI) findings in cases of complications following anterior cruciate ligament (ACL) reconstructive surgery, and to correlate these complications with their possible etiological factors based on clinical and radiological criteria.

Methods

The study included 48 symptomatic patients (40 males and 8 females) after arthroscopic ACL reconstruction in the period between 2006 and 2008. Clinical evaluation of the patients was performed using the International Knee Documentation Committee scoring system (IKDC). MRI was performed using 1.5 T dedicated system and a standard imaging protocol. The scans were then reviewed by two senior radiologists for the assessment of integrity of the reconstructed ligament and the presence of related complications. The findings were then analyzed and correlated with the clinical evaluation.

Results

Tunnel widening was the most common MRI finding seen, as it was present in 42 patients (87.5%). The detected post reconstructive complications encountered in our patients included graft tear in 34 patients (70.83%), impingement in 12 patients (25%), osteoarthritis in six patients (12.5%), cystic degeneration in two patients (4.16%), and Cyclops lesion in two patients (4.16%).

Conclusions

MRI is a valuable imaging modality for assessment of post ACL reconstructive complications, as it is useful in demonstrating tunnel positioning, graft integrity and other soft tissue structures of the knee. It also helps in identifying possible underlying causes and predisposing factors for ACL graft failure.     

Repeated courses of antenatal corticosteroids: Are there effects on the infant's auditory brainstem responses?

Our objective was to assess the effects of repeated antenatal corticosteroid treatments on the neonatal auditory brainstem response (ABR), a sensitive measure of neonatal brain maturity and auditory function. To achieve this, we performed and blindly evaluated neonatal ABRs on a subset of infants delivering within a multicenter randomized placebo-controlled clinical trial comparing single versus repeated courses of antenatal corticosteroid treatments for women at 23–31 weeks gestation who remained at increased risk for preterm birth. The women were randomly assigned to either the single or the repeated antenatal corticosteroid treatment group. Women in the repeated antenatal corticosteroid group received weekly antenatal corticosteroid treatments until 34 weeks gestation or until they reached a study-determined limited number of courses, whereas women in the single antenatal corticosteroid group received an initial course of corticosteroid followed by weekly placebo injections. We performed ABR testing on their infants prior to discharge. The latencies of waves I, III and V and the peak-to-trough amplitudes of waves I and V were compared between those in the single (n = 27) and repeated antenatal corticosteroid treatment (n = 24) groups. The majority of repeated antenatal corticosteroid infants (20 of 24) were exposed to ≥ 4 antenatal corticosteroid treatments. Even though gestational age was similar between our subset of single and repeated antenatal corticosteroid treatment groups, infant birth weight and length and head circumference were significantly smaller in the repeated antenatal corticosteroid group (p < 0.05). Despite these differences in birth sizes, there were no significant group differences in the ABR wave latencies or amplitudes. We concluded that our repeated antenatal corticosteroid treatments, in comparison to a single treatment, did not significantly benefit or harm the neonatal ABR despite significant effects on birth size.