Eosinophilic colitis in a patient with advanced transitional cell carcinoma of the bladder: a paraneoplastic syndrome?

Eosinophilia associated with tumors is extremely rare. The exact underlying pathogenetic mechanisms are not well understood; limited data have been reported about granulocyte colony-stimulating factor and interleukin-5 in the development of eosinophilia. We report a patient with marked eosinophilia, leukocytosis, and eosinophilic colitis presenting with bloody stool. The subsequent diagnosis was advanced high-grade transitional cell carcinoma of the bladder. Leukocyte count, eosinophil count, and colonoscopic findings returned to normal after surgical removal of the tumor. To our knowledge, eosinophilic colonic infiltration as a manifestation of transitional cell bladder carcinoma has not been previously reported.     

Relationship between the G protein–coupled oestrogen receptor and spermatogenesis,and its correlation with male infertility

The aim of this study was to investigate the diagnostic value of serum G protein–coupled oestrogen receptor (GPER) levels and their correlation with semen parameters in men with infertility. The participants were divided into two groups as follows: 76 fertile control men (Group 1) and 77 infertile men (Group 2). Semen analysis, hormonal evaluation, serum GPER level and scrotal ultrasound of the participants were evaluated. Follicle-stimulating hormone and total testosterone levels were not significantly different between the groups (p = .413 and p = .535 respectively). The oestradiol level in Group 1 was significantly lower than that in Group 2 (p < .001). The serum GPER level was found to be significantly higher in Group 1 than that of Group 2 (p < .001). GPER levels were positively correlated with the total sperm count, sperm concentration, motility and morphology in Group 2 (r = 0.303, 0.345, 0.260 and 0.322, respectively, p < .001). In this study, GPER levels were positively correlated with sperm parameters, and it was hypothesised that the decrease in GPER expression might be associated with male infertility by adversely affecting spermatogenesis.     

Use of Ligasure in Thyroidectomy Procedures: Results of a Prospective Comparative Study

The thyroidectomy procedure requires many manupulations to achieve prompt hemostasis. This study assessed whether the outcomes of thyroidectomy using the Ligasure electrothermal vessel sealer were comparable with the conventional suture-ligation technique. We prospectively evaluated 58 consecutive patients who underwent thyroidectomy. Patients were allocated into two groups according to their preference. There were 30 patients in the Ligasure group and 28 patients in the conventional surgery group. Complications, operating time, and hospital stay were compared between the two groups and suture-ligations performed in the Ligasure group were recorded. The age, sex, and indications were similar in the two groups (p > 0.05). Complication rates and hospital stays did not show any difference according to the techniques used. Operating time was shorter in the hemithyroidectomy and total thyroidectomy patients of the Ligasure group (mean ± SD: 77.38 ± 13.71 vs. 99.80 ± 12.53 minutes, p = 0.005; and 102.50 ± 16.69 vs.128.89 ± 19.74 minutes, p = 0.010). The mean ± SD number of suture-ligations for each patient in the Ligasure group was 1.83 ± 2.12. Thyroid surgery using the Ligasure is safe, and its complication rates are comparable to these found with the conventional surgical technique. Use of the Ligasure during hemithyroidectomy and total tyhroidectomy operations provides a significantly shorter operating time.     

Our Experience of Anatomical Variations of Facial Nerve in Cadaveric Temporal Bone Dissection

Cadaveric dissections helps aspiring ear surgeon to learn anatomy of temporal bone so as to avoid injury to the many vital structures. Objectives are to study the course of facial nerve and its variation in 50 cases of temporal bone dissection. To study the various parameter of the tympanomastoid segments of facial nerve, its relation with the important middle ear structures and their variations. To study the incidence of anatomical variations such as dehiscence of bony canal of facial nerve, bony overhang in the oval window region. The Current study was conducted at Dept. of ENT Temporal bone lab. 50 temporal bones were dissected to study the various parameters of the tympano-mastoid segments of the facial nerve, its relations with the important middle ear structures and their anomalies. The present study was carried out from Jan 2016 to Jan 2019. Out of 50 bones dissected, 44 (88%) bones were well pneumatised and 6(12%) bones were sclerotic. Length of the tympanic segment varied from 7.8 to 11.88 mm with a mean of 9.47 mm (± 1.06 mm). In 17 bones (34%) length of the mastoid segment was 13.1–14 mm, in 12 bones (24%) the length was 14.1–15 mm, while in 10 bones (20%) it was 12–13 mm. In 6 bones (12%) it was 15.1–16 mm and < 12 mm in 5 other bones (10%). The distance of second genu from outer cortex varied from 17.87–23.67 mm with a mean of 19.64 mm (± 1.42 mm).Distance of chorda tympani from stylomastoid foramina varied from 3.4–7.8 mm with a mean of 5.69 mm (± 1.51 mm). The study has provided knowledge of anatomy of temporal bone and its pneumatization pattern, the anatomy of the facial nerve, its variations and their incidence, relation of various middle ear landmarks with the facial nerve and proficiency in dissection.     

Intravenous paracetamol improves the quality of postoperative analgesia but does not decrease narcotic requirements

Paracetamol, a centrally acting inhibitor of cyclooxygenase, has less gastrointestinal and platelet-inhibiting side effects and is clinically better tolerated than nonsteroidal anti-inflammatory drugs. Therefore, it will be ideally suited for postoperative pain relief. In this prospective, double-blind, randomized, placebo-controlled study, we evaluated the analgesic efficacy, opioid-sparing effect and effects on opioid-related adverse effects of intravenous (IV) paracetamol in combination with IV morphine after lumbar laminectomy and discectomy. Forty patients were divided into 2 groups (n=20 each) to receive either paracetamol 1 g (group 1) or 0.9% NaCl 100 ml (group 2) at the end of the operation and at 6-hour intervals over 24 hours. IV patient-controlled analgesia with morphine was used as a rescue analgesic in both groups. Pain was evaluated at rest and on movement at the 1st, 2nd, 4th, 6th, 12th, 18th, and 24th hours using a visual analog scale. Hemodynamic parameters, morphine usage, patient satisfaction, and probable side effects were also evaluated. Pain scores at rest and on movement at the 12th, 18th, and 24th hours were significantly lower in group 1 (P<0.001). Morphine consumption was not statistically significantly different between the groups (P>0.05). Vomiting in group 2 was significantly higher (P=0.027). Significantly more patients in the paracetamol group rated their pain management as excellent (45% vs. 5%). Although repeated IV paracetamol usage after lumbar laminectomy and discectomy did not demonstrate a significant opioid-sparing effect, it did decrease visual analog scale scores at certain evaluation times and incidence of vomiting and increase patient satisfaction.     

Hepatotoxicity induced by alendronate therapy

Here we describe a 47-year-old postmenopausal woman who had been taking alendronate 70 mg/week for osteoporosis. After two months of alendronate therapy, she developed hepatotoxicity, and no other etiological factors for this besides the alendronate were apparent. After the alendronate therapy was discontinued, the patient’s hepatic enzyme levels slowly returned to normal. Hepatotoxicity due to alendronate therapy is a rare but possible adverse effect.