Current treatment of hepatitis C virus infection

New strategies have led to better results in the treatment of HCV infection during the last few years. At present the recommended treatment for patients with chronic hepatitis C is a combination of pegylated interferon and ribavirin. The sustained virological response rate of this combination therapy is 42 - 48 % for patients with genotype 1 after a course of 48 weeks and 80 % for patients with genotype 2 or 3 after a course of 24 weeks. New nucleoside analogs may lead to a better tolerance and better outcomes. A new approach is the long term monotherapy with pegylated interferon in order to reduce the progression of fibrosis and the incidence of cirrhotic complications. At present the effectivity of protease inhibitors and of a therapeutic immunisation with the E1 envelope protein of the hepatitis C virus are being examined. Because the optimal treatment strategy for patients with an acute hepatitis C infection is still unclear, these patients should be included in clinical studies.     

An extremely uncommon infection: Candida glabrata arthritis after total knee arthroplasty

Prosthetic arthritis caused by Candida species is extremely rare. Of 30 such cases reported in the English literature, only 3 were due to Candida glabrata. We present herein a fourth case; to the best of our knowledge this is the first example of knee arthroplasty infection caused by C. glabrata.     

Bilateral lower extremity arterial thromboembolism mimicking conversion disorder

Thromboembolic causes of acute limb ischemia are not frequent; however, an immediate true therapy is needed to save the extremity. Here we presented a case with bilateral lower extremity arterial thromboembolism mimicking conversion disorder. Conversion disorder and acute arterial embolism can be confronted in different patterns. This case proved us that anamnesis can be misleading and manipulating to evaluate patients. Furthermore, our report may potentially highlight the inadequacies in the guidelines for diagnosis.     

Successful treatment of long spontaneous coronary dissection with medical management: Not to intervene

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute coronary syndrome (ACS) and optimal therapy has not been well-defined. We present a case of long SCAD with complete healing due to medical management. A 47-year-old woman presented to emergency department because of sudden onset of typical chest pain. Electrocardiogram (ECG) showed minimal ST-segment elevation in leads V1–V4. Coronary angiography showed a long spiral dissection extending from the middle segment to the distal segment of the left anterior descending artery and TIMI flow grade three. We decided to follow-up with medical management and have control angiography unless hemodynamic instability and chest pain emerged. Control angiography displayed complete healing of dissect segment after six months. SCAD should be considered, especially in women who present with an ACS without a history of cardiovascular disease and risk factor. This report offers the idea that medical management can be a choice even if in the long segment SCAD setting.     

Nine cases of nonpalpable testicular mass: an incidental finding in a large scale ultrasonography survey

Objectives: Nonpalpable testicular masses are usually diagnosed during routine ultrasonography (US) examinations for other conditions. There are conflicting results on the final diagnosis and management of these lesions. In the present study we report the results of a large US series of 5104 patients on nonpalpable testicular masses and discuss the management of these patients. Methods: This retrospective observational study was performed in a secondary care military hospital. A total of 5104 patients underwent a US and 11 of them were diagnosed as having a nonpalpable testicular mass. These 11 patients also underwent magnetic resonance imaging (MRI). Two of them refused surgery and were excluded from the study. The remaining nine patients underwent intraoperative US‐guided localization and excisional biopsy of the non‐palpable testicular parenchymal mass. A radical orchiectomy was required in all of them. US and MRI findings, frozen and final pathology results were recorded. Results: The median age of study subjects was 24 years. The final pathology revealed a malign tumor in eight patients and an inflammatory mass in one patient. There were inconsistent results in four patients between frozen section analysis and final pathology. MRI improved the definition of the solid masses in all patients. Conclusions: MRI enhances the certainty of the diagnosis of malignity in nonpalpable testicular masses, particularly in conditions that generally can not be diagnosed with ultrasonography alone. Frozen section analysis is not an accredited method in diagnosing malign lesions in non‐palpable testicular masses.     

Acute intoxication with doxazosin

Experience with overdosage and toxicity with the alpha-adrenoreceptor antagonists remains very limited in the literature. In this paper, the second case in the literature with doxazosin overdosage is reported. Supportive treatment was given to the patient and the patient was discharged 48 hours after admission to the emergency department.