Severe postnatal cytomegalovirus infection with multisystem involvement in an extremely low birth weight infant

Cytomegalovirus (CMV) infection is the most common intrauterine and perinatal viral infection. Postnatal CMV infection is acquired mainly from breast milk and may cause severe illness in preterm infants. We report an extremely low birth weight infant who presented with a sepsis-like syndrome and multiple organ involvement, notably hepatitis and pneumonitis, and treated with ganciclovir without adverse effect or relapse.

Symptomatic foraminal extradural meningeal cyst

The authors described the case of a 39-year-old man with Klippel-Trénaunay syndrome, who had an extradural meningeal cyst expanding into intervertebral foramen of lumbar 2 and 3 vertebrae. The patient suffered from low back pain radiating to the left lower extremity. Magnetic resonance imaging revealed a huge extradural meningeal cyst growing through intervertebral foramen far laterally. A widened neural foramen of L2 and L3 vertebrae was observed on his plain radiography. The cyst was totally excised after tying the ostium connecting the subarachnoid space of the dural sac. This case supports the congenital theory in the pathogenesis of spinal cysts because the Klippel-Trénaunay syndrome is a congenital disorder including a mesodermal abnormality which may be the causative factor for a congenital defect in dura.

Efficacy of prognostic factors on survival in patients with low grade glioma

AIM

In this report, we aim to determine the prognostic factors influencing the length of survival in patients with low-grade gliomas.

MATERIAL AND METHODS

In a retrospective evaluation, we have reviewed fiftythree patients who had been operated between the years of 1980 and 2006. The diagnoses of the patients were histopathologically verified as low-grade glioma(LGG). The medical records of the patients were reviewed for age, gender, tumor locations, extent of resection, and presence of seizure, the neurological status as defined by the Karnofsky Performance Scale (KPS) and radiotherapy treatment after surgery as possible prognostic factors.

RESULTS

Median cumulative survival time for all the patients with LGG was 141+/-14.83 months. Median survival time was 216+/-78.52 months for astrocytoma Grade I; 115+/-8.22 months for astrocytoma Grade II, and 242+/-76.36 months for oligodendroglioma. Young age, histology subtype (oligodendroglioma) and preoperative KPS were determined to have positive influence on survival according to Log Rank Test. In contrast, age, histology type and the extent of resection remained independent prognostic factors upon survival when Cox Regression Backward Stepwise (Wald) method was performed.

CONCLUSION

It can be concluded that surgery seems to be an appropriate first step option in the treatment of LGG.

An unusual case of cervical clear-cell meningioma in pediatric age

INTRODUCTION AND BACKGROUND

A 4-year-old girl was admitted with complaints of diplegia, right lower limb monoplegia, and left lower limb monoparesia. Cervical magnetic resonance imaging revealed an intradural-extramedullary tumor at the level of C1-C2. The tumor was resected totally. Histopathologic diagnosis revealed clear-cell meningioma.

DISCUSSION

Intraspinal clear-cell meningioma (ICCM) is a rare aggressive variant of meningioma. There are only 25 cases reported to date, and only 13 of them are in pediatric age group. Of these 25 ICCM cases, only two are at cervical region. This report is the first ICCM case at upper cervical region (C1-C2) in both adult and pediatric age populations.

Benign clear cell adenofibroma of the ovary. A case report with literature review

Most clear cell neoplasms of the ovaries are carcinomas; benign and borderline clear cell tumors are uncommon. To date, only 12 cases of benign clear cell adenofibroma have been reported in the literature. Here we report a case of benign clear cell adenofibroma of the left ovary in a 51-year-old postmenopausal woman. Histological examination revealed widely spaced simple glands embedded in a dense fibrous stroma. The glands were lined by one to two layers of cells with abundant clear cytoplasm. The nuclei were bland and uniform in size and shape. There was minimal cytologic atypia in some areas. In this article we discussed the criteria for the diagnosis of benign and borderline clear cell adenofibromas and reviewed the literature.

PAP smear screening among married women living in Osamangazi University ALPU training area

An inquiry including questions about socio-demographic and fecundity properties and covering the knowledge and attitudes of women about Pap smears was applied to 585 women living in Alpu district of Eskisehir, Turkey. Smear specimens were taken from 513 women and colpography was performed before and after acetic acid application with a digital camera. The women who had cervical lesions and/or aceto-white epithelium during the gynecological examination and/or had pathological findings in the smear and/or had suspicious findings at the colpography were invited (n=125, 24.4%) to the Department of Gynecology for colposcopic evaluation. Colposcopy was performed to 77 and biopsies were taken from 40 of the women during colposcopic examination. Of the biopsy specimens, 31 were accepted as benign while 9 were reported as pathology positive, one being high grade squamous intraepithelial lesion (HGSIL) and 8 low grade squamous intraepithelial lesion (LGSIL).

Peripheral intrapulmonary lipoma: a case report and review of the literature

Lipomas are common benign tumours, but intrathoracic lipomas are rare and peripheral lung lipomas are exceptionally rare. Eight cases have been described in the world literature. We report a case of lipoma arising in the periphery of the left lower lung in a 54-year old woman. Grossly, it was presented as a well- circumscribed, thinly encapsulated, rounded, pale yellow mass. A wedge resection was done of the left lung and the microscopic findings revealed lipoma of the lung. The present paper recapitulates the macroscopic and microscopic features, the treatment and the differential diagnosis of this rare neoplasm.

Plasmacytoid myoepithelioma of the soft palate: a review of the literature and report of a case with immunohistochemical findings

Myoepitheliomas of salivary glands are rare neoplasms, accounting for less than 1% of all salivary gland tumors. They are classified into four cell types: epithelioid, spindle, clear, and plasmacytoid. Among them, the plasmacytoid cell type appears to have a predilection for the oral cavity, especially the palate. We presented a 32-year-old man with plasmacytoid myoepithelioma arising in the soft palate, together with a brief discussion of the clinicopathologic features and differential diagnosis in the light of the literature.

Pulmonary involvement in childhood-onset systemic lupus erythematosus: a report of five cases

OBJECTIVE

Systemic lupus erythematosus (SLE) is a chronic systemic disease, which can involve multiple organs such as kidney, skin and brain. Lung is another organ that can be affected. A number of pulmonary complications including pleuritis, pneumonitis, infectious pneumonia, pulmonary haemorrhage, pulmonary hypertension and pneumothorax have been reported in patients with SLE. Pulmonary involvement is relatively frequent in adult patients; it has infrequently been reported in children with SLE. However, pulmonary manifestations may be an initial and/or life-threatening complication of SLE in children. In this paper we aim to emphasize the pulmonary involvement in childhood-onset SLE via description of our patients.

METHODS

The patients, who were diagnosed with SLE at the Children's Hospital of Ankara University Medical School between 1993 and 2002, were retrospectively evaluated for evidence of pulmonary involvement. All patients fulfilled at least four of the classification criteria of the American Rheumatism Association. Using a standardized form, we obtained data regarding the age, sex and presenting complaints of the patients, previous therapies given, clinical and laboratory features, treatment and outcome. Informed consent was obtained from all patients.

RESULTS

During the 10-yr study period, 16 patients were diagnosed with childhood-onset SLE. Five of them (31%) had pulmonary involvement including acute lupus pneumonitis, invasive pulmonary aspergillosis, cytomegalovirus pneumonia and pulmonary haemorrhage (in two patients). These 5 patients with lupus lung disease are presented in more detail.

Agenesis of sphenoid sinuses

We present a 50-year-old woman with agenesis of the sphenoid sinuses. She was referred for evaluation of the aeration status of the sphenoid sinus and related nasal structures before endoscopic transsphenoidal hypophysectomy for pituitary microadenoma. Axial and coronal computed tomography (CT) scans revealed absence of the sphenoid sinuses and the right posterior ethmoidal cell. Agenesis of sphenoid sinuses documented using CT scans is uncommon. One case with a history of Hand-Schuller-Christian disease has been reported in the English language literature. In the case reported here agenesis of the sphenoid sinuses was not accompanied by craniofacial anomaly or skeletal disease.

Pneumatization of the inferior turbinate

Pneumatization of the inferior turbinate is an extremely rare intranasal anatomical variation. Only a few cases have been reported yet. In this paper we present two cases, one unilateral and one bilateral case with pneumatization of the inferior turbinate.

Investigation of risk factors for penicillin-resistant Streptococcus pneumoniae carriage in Turkish children

BACKGROUND

Nasopharyngeal colonization plays an important role for infections caused by Streptococcus pneumoniae. Emergence of penicillin resistance in this organism has made it difficult to treat pneumococcal infections. The objectives of this study were to investigate the risk factors for nasopharyngeal colonization with S. pneumonia and for nasopharyngeal colonization with penicillin-resistant S. pneumoniae.

METHODS

Three hundred children with or without evidence of infection were investigated for various risk factors. Streptococcus pneumoniae isolated from children's nasopharyngeal swabs were examined for penicillin susceptibility.

RESULTS

Day-care attendance (odds ratio OR=2.82, P=0.003) and upper respiratory tract infection within the last month (OR=1.83, P=0.02), have been determined to be risk factors for S. pneumoniae carriage. The use of antibiotics within the last 3 months (OR=81.07, P<0.001), the presence of more than five people living in the house of the child (OR=6.63, P=0.03), and having a sibling under 5-years-old (OR=4.60, P=0.03) have been determined to be risk factors for penicillin-resistant S. pneumoniae carriage.

CONCLUSION

Some children are inevitably exposed to and colonized with penicillin susceptible or resistant S. pneumoniae. Changes in day-care organizations, better living conditions, and restriction of antibiotic use seems to be useful precautions to prevent the emerging and colonization with penicillin-susceptible or -resistant S. pneumoniae.

Nasopharyngeal colonization with penicillin-resistant Streptococcus pneumoniae in Turkish children

BACKGROUND

Streptococcus pneumoniae is one of the major infectious agents observed in children. In spite of the fact that penicillin is preferred in the treatment of infections caused by S. pneumoniae, there has been a world-wide increase in the frequency of penicillin-resistant S. pneumoniae.

METHODS

One hundred and fifty sick children with a clinical diagnosis of pneumonia, meningitis, acute otitis media, acute sinusitis and septicemia or bacteremia, and 150 healthy children without any infection were examined. Streptococcus pneumoniae, which were isolated from the nasopharynx, were analyzed with respect to penicillin susceptibility using the agar dilution method.

RESULTS

The S. pneumoniae carriage rate was observed to be 43.3% in the group of sick children and 30.0% in the control group (P < 0.05). The penicillin resistance of S. pneumoniae isolated from the nasopharynx was determined to be 35.4% from a total of 110 isolates, with an intermediate resistance of 32.7% and a high resistance of 2.7%. The penicillin resistance of S. pneumoniae carried in the nasopharynx was determined to be 41.5% in the group of sick children and 26.6% in the control group (P > 0.05). Resistance rates of other antibiotics were determined as follows: cefotaxime 2.7%, erythromycin 19%, clarithromycin 5.4%, tetracycline 21.8%, trimethoprim-sulfamethoxazole 4.5% and rifampin 0%.

CONCLUSIONS

Penicillin resistance of S. pneumoniae has recently become a problem in Turkey. Because of this, we require new strategies to limit the spread of drug-resistant S. pneumoniae.

Unilateral megalencephaly associated with contralateral neuronal migration defect

A case of unilateral megalencephaly associated with contralateral cortical dysplasia and grey matter heterotopia is reported. The corpus callosum is a genetic and the basal ganglia are dysplastic.

Multifocal bone tuberculosis presenting as a breast mass: CT and MRI findings

Chest wall involvement is an uncommon manifestation of musculoskeletal tuberculosis. We present computed tomography and magnetic resonance imaging findings in a case with multifocal musculoskeletal tuberculosis presenting as a breast mass. These radiological modalities are not diagnostic without histopathological confirmation, but they are valuable guides to surgery in defining the extent of disease involvement.

Intradural-extramedullary spinal cysticercosis: MR imaging findings

A rare case with intradural-extramedullary cysticercosis is presented here. MR imaging with and without gd-DTPA were performed. There were multiple cysts in the basal cistern, cisterna magna, and cervical subarachnoid space which were isointense with cerebrospinal fluid both on T2- and T1-weighted images. Swelling and increased signal intensity in the cord parenchyma were detected on T2-weighted images. Gadolinium enhanced studies showed rim-shaped enhancement in the cysts and irregular, diffuse enhancement in the meninges.

MR findings of primary central nervous system lymphoma in a child. A case report

MR imaging of a rare case of primary central nervous system lymphoma in a 12-year-old boy with headache and seizure is presented. MR imaging showed a mass lesion located in the corpus callosum. Diagnosis was made by stereotactic biopsy. The patient was treated with radiotherapy. Early control MR imaging showed a decrease in tumor size but after 12 months an increase in tumor size was detected.

Abdominal tuberculosis. A case report

Tuberculous involvement of the abdominal parenchymatous organs is usually a diffuse process. The macronodular form of hepatosplenic tuberculosis and focal involvement of the pancreas are extremely rare. This report describes CT findings of abdominal parenchymatous organ involvement in a patient with pulmonary and vertebral tuberculosis. Although CT does not confirm a diagnosis of abdominal tuberculosis, it is a valuable examination that can support the diagnosis and define the extent of disease.

Tuberous sclerosis: ultrasound, CT and MRI features of two cases with multiple organ involvement

The cases of two patients with tuberous sclerosis with multiple sites of involvement are presented. Both patients had characteristic cerebral lesions of tuberous sclerosis associated with bilateral renal angiomyolipomas and hepatic hamartomas. Additionally there were diffuse pulmonary cystic changes in one patient and cardiac rhabdomyoma in the other.

Does large-bowel enema reduce septic complications in acute pancreatitis?

BACKGROUND

The source of septic complications in acute pancreatitis was unknown until recent years. The pathogenesis of bacterial translocation from the gut has been accepted as the main source of pancreatic or peripancreatic infection. This study was designed to investigate the role of large bowel enema during acute pancreatitis in preventing bacterial translocation.

MATERIALS AND METHODS

Twenty-four Spraque-Dawley rats were used in this study. The rats were divided into two groups. Group I animals received biliopancreatic duct ligation plus colon cleansing by rectal enemas; group II animals received only biliopancreatic duct ligation. Rectal enemas were applied to the first group of animals three times, at 6, 24, and 48 hours after the operation using 10 cc sodium hydrogen phosphate solutions. All animals were sacrificed 72 hours later, and tissue samples were taken from mesenteric lymph nodes, pancreas, spleen, and liver for bacteriologic cultures via a midline laparatomy. Blood and cecum cultures were also prepared.

RESULTS

Positive mesenteric lymph node cultures were found in all 12 animals in group II but in only 3 of 11 animals of group I (P <0.05). Distant organ cultures were positive in 9 of group II, but the only infected distant organ culture found in group I was the positive liver culture (P <0.05).

CONCLUSION

As a result of this study, we believe that large bowel enema can reduce the frequency of septic complications in acute pancreatitis by reducing bacterial translocation.

Acute myeloblastic leukemia associated with hyperleukocytosis and diabetes insipidus

Two cases with acute myeloblastic leukemia (AML M4-FAB) associated with diabetes insipidus (DI) are presented here. Both patients presented with hyperleucocytosis. One had a white blood cell count (WBC) of 150 x 10(9)/L and the second patient had 200 x 10(9)/L. One of these patients was a 40 year-old male and MRI of the hypophysis showed an infindibuler mass. This patient did not respond to remission induction chemotherapy and reinduction chemotherapy was given. The other patient was a 16-year-old male with a normal CT scan of the head. Both patients had DI with typical clinical and laboratory findings. The first patient died early on during reinduction chemotherapy and the second patient died of intracranial bleeding before induction chemotherapy was given. These findings are consistent with the data in the literature suggesting that the prognosis of AML associated with DI is poor and that these cases generally present with hyperleucocytosis.

MRI in primary intraspinal extradural hydatid disease: case report

A rare case of pathologically proven primary intraspinal extradural hydatid disease of the thoracic region with spinal cord compression is reported. The diagnosis was established preoperatively on the basis of the MRI findings. The patient underwent surgery and recovered completely.

Brucellosis of the pituitary region: MRI

We report a rare case of neurobrucellosis in a 25-year-old woman with visual impairment, bilateral hearing loss, hyperprolactinaemia and meningitis. MRI revealed a sellar and suprasellar mass with enlargement of the optic chiasm.

MR imaging in a desmoid tumor of the posterior mediastinum with extension into the abdominal cavity. A case report

We report on a rare case of desmoid tumor in a 40-year-old man with low back pain and cough. There was no history of previous surgery or trauma. MR imaging revealed a posterior mediastinal mass extending into the abdominal cavity.