Simultaneous Bilateral Stenosis of the Vertebral Arteries Treated by Unilateral Decompression: A Case Report

A 56-year-old man presented with a 3-month history of progressive dizziness. His dizziness was aggravated when his head was rotated to the right side. Diagnostic angiography showed that a normal right-sided vertebral artery in the neutral position became an abnormal vertebral artery with two stenotic lesions at the C3–4 and C5–6 levels when the patient’s head was turned to the right. A normal left-sided vertebral artery also showed a stenotic lesion at the C2 level when the patient’s head was turned right. The axial dimensions of the bilateral vertebral arteries were similar. The patient was successfully treated with decompression of only one level (C5–6). We conclude that if a bilateral stenosis is found upon one directional head rotation and the bilateral vertebral arteries are similarly sized, a one-sided treatment may suffice.     

The effect of single or multiple courses of antenatal corticosteroid therapy on neonatal respiratory distress syndrome in singleton versus twin pregnancies

Background: Antenatal corticosteroid (ACS) treatment is widely used for the prevention of respiratory distress syndrome (RDS) in preterm infants. However, the efficacy and safety of ACS treatment remains controversial in twin pregnancies.
Aims: To investigate the effect of ACS therapy, single or multiple courses, on the incidence of neonatal RDS in singleton and twin pregnancies.
Methods: We retrospectively evaluated the pregnancy and neonatal outcomes of 450 singleton and 117 twin pregnancies delivered at 24–34 weeks of gestation due to preterm labour or preterm premature rupture of membranes. The subjects were categorised into four groups according to ACS exposure: 0, 1, 2 and ≥ 3 courses.
Results: Overall, RDS occurred more frequently in twins compared to singletons (41.0% vs 25.3%, P  < 0.001). In singleton pregnancy, the incidence of RDS was significantly lower in the ACS user groups than in the non-user group, with the lowest incidence in the multiple course groups. An increase in the number of courses of ACS was associated with a reduction in the incidence of RDS (odds ratio 0.349, 95% confidence interval 0.226, 0.537, P  < 0.001) independent of confounding variables. In twin pregnancies, however, the incidence of RDS was not significantly different in comparisons among the four groups.
Conclusion: Multiple courses of ACS were associated with a significantly decreased risk of RDS in singleton pregnancies. However, the current standard dose or interval for ACS administration in singleton pregnancy, as either a single or multiple courses, did not reduce RDS in twins.     

Papular acantholytic dyskeratosis of the vulva

We describe a 63-year-old woman with an asymptomatic papular eruption on the vulva. Clinically, the lesions showed multiple pin-head-sized whitish papules on the labia major. Histologically, the biopsy specimen showed acantholysis throughout the epidermis with the presence of dyskeratotic cells resembling corps ronds and grains, hyperkeratosis and parakeratosis. These clinical and histological findings were consistent with the diagnosis of papular acantholytic dyskeratosis of the vulva which is a rare disorder, first described in 1984.