Does HIV co-infection promote Echinococcus dissemination?

SUMMARY: The influence of human immunodeficiency virus (HIV) on the severity of hepatic cystic echinococcosis (CE) is uncertain. HIV-modulated immune suppression may increase the risk of contracting CE with less self-limiting disease, more rapid progression, and a higher likelihood of complications. A 30-year-old male with concurrent, untreated HIV underwent surgery for two large, complicated hepatic CE cysts, which were replacing the right hemiliver, and innumerable peritoneal daughter cysts. At operation, 30 kg of cystic material was removed from the liver and peritoneal cavity. Despite postoperative complications, including cardiac arrest, respiratory failure, and a bile leak, the patient made a full recovery.

Trans-arterial therapy for Fibrolamellar carcinoma: A case report and literature review.

INTRODUCTION: Fibrolamellar carcinoma (FLC) is a rare pathologically distinct primary liver cancer. Surgical resection is the only treatment associated with prolonged survival. Trans-arterial embolization (TAE), which is a recognised treatment for hepatocellular carcinoma has been used to treat FLC. We present a case and performed a literature review of patients with FLC treated with TAE. CASE PRESENTATION: We present a 19-year old female with a large potentially resectable FLC which was initially treated with trans-arterial chemo-embolization (TACE) with drug eluting beads. The TACE was followed by surgical resection. Histology confirmed tumour necrosis related to the previous TACE. DISCUSSION & LITERATURE REVIEW: We identified seven case reports and one case series of TAE for FLC. TAE was either used as a neo-adjuvant therapy to facilitate subsequent tumour resection or as a palliative treatment modality. We propose an algorithm for the treatment of FLC that includes TAE. CONCLUSION: The rarity of FLC and the paucity of data precludes establishing clear evidence-based standards of care. We propose an algorithm for the treatment of FLC. The establishment of an international registry may facilitate the collection of better quality evidence.

Reliability of diffusion-weighted magnetic resonance imaging in differentiation of recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy.

OBJECTIVE: To assess the reliability of diffusion-weighted magnetic resonance imaging in differentiating recurrent cholesteatoma from granulation tissue after intact canal wall mastoidectomy. METHODS: A prospective study was conducted of 56 consecutive patients with suspected cholesteatoma recurrence after intact canal wall mastoidectomy who underwent diffusion-weighted imaging and delayed contrast magnetic resonance imaging of the temporal bone. The final diagnosis was recurrence in 38 patients and granulation tissue in 18 patients. RESULTS: Cholesteatoma detection on diffusion-weighted imaging based on two sets of readings had sensitivity of 94.7 and 94.7 per cent, specificity of 94.4 and 88.9 per cent, and accuracy of 94.6 and 92.8 per cent, with good intra-observer agreement (Κ = 0.72, p = 0.001). Cholesteatoma detection on delayed contrast magnetic resonance imaging had sensitivity of 81.6 and 78.9 per cent, specificity of 77.8 and 66.7 per cent, and accuracy of 80.4 and 75.0 per cent, with fair intra-observer agreement (Κ = 0.57, p = 0.001). The mean cholesteatoma diameter on diffusion-weighted imaging was 7.7 ± 1.8 and 7.9 ± 1.8 mm, with excellent intra-observer agreement (Κ = 0.994, p = 0.001). CONCLUSION: Diffusion-weighted imaging is a reliable method for differentiating recurrent cholesteatoma and granulation tissue after intact canal wall mastoidectomy.

Occupational exposure to mercury among workers in a fluorescent lamp factory, Quisna Industrial Zone, Egypt.

BACKGROUND: With the fast growth in the market of fluorescent lamps, particularly compact fluorescent light, the associated risk of mercury exposure, which is an essential component in all types of fluorescent lamps, has received increasing public attention worldwide. Even low doses of mercury are toxic. OBJECTIVE: To study the health consequences of occupational exposure to mercury in workers of a fluorescent lamp factory. METHODS: In a cross-sectional study 138 workers of a fluorescent lamp factory and 151 people who had no occupational exposure to mercury (the comparison group) were studied. Environmental study of mercury and noise levels was done. For all participants a neurobehavioral test battery was administered, spirometry was performed and air conduction audiometry was done. Urinary mercury level was also measured for all participants. RESULTS: Prominent symptoms among workers exposed to mercury included tremors, emotional lability, memory changes, neuromuscular changes, and performance deficits in tests of cognitive function. Among the exposed group, the mean urinary mercury level was significantly higher in those who had personality changes or had manifestations of mercury toxicity. With increasing duration of employment and urinary mercury level, the performance of participants in neurobehavioral test battery and spirometric parameters deteriorated. CONCLUSION: Neurobehavioral test battery must be used for studying subclinical central nervous system dysfunction in those with chronic exposure to mercury. The test is especially useful for evaluating the severity of mercury effects in epidemiological studies. This study also reinforces the need for effective preventive programs for fluorescent lamp industry workplaces especially in developing countries with the lowest unhygienic work conditions.

Oral anticoagulation therapy during pregnancy in patients with mechanical mitral valves: a prospective study.

Reports on phenindione toxicity have limited its use as an oral anticoagulant. Our aim was to evaluate its risks in pregnant women. Thirty-one pregnancies in 29 women with mitral (+/-aortic) St. Jude mechanical valves were followed-up prospectively. Eighteen patients received phenindione. Eleven patients (37.9%) received in addition to phenindione 225 mg dipyridamole, which was given in three doses. The target INR was 2.5-3.5 in the former and 2-2.5 in the latter treatment. A fortnight before delivery, intravenous heparinotherapy was substituted. There were no maternal complications, apart from a single postpartum hemorrhage (3.2%). After the deliveries the results were: 26 mature babies (83.9%), 3 premature babies (9.7%) and 2 cases of stillbirth (6.4%). Outcome was dose related; being 57.2+/-20.9 mg/day for mature babies and 82.5+/-11.2 mg/day for prematures and stillbirths (P=0.016). Phenindione provided safe and effective anticoagulation during pregnancy. A larger study is necessary to confirm the relationship between the dosage and outcome.

A comparative analysis of the rate of meiosis, chiasma frequency and terminalization in the Jerboas Allactaga and Jaculus (Rodentia: Dipodidae) in Egypt.

The rate of seven meiotic stages (zygotene-pachytene, diplotene-diakinesis, metaphase I, anaphase I, metaphase II, anaphase II, and quartet) was studied in the jerboas Jaculus jaculus jaculus, Jaculus orientalis, and Allactaga tetradactyla, chiasma frequency and terminalization being examined only in J. jaculus and J. orientalis, and compared with the previous data concerning A. tetradactyla. Significant differences in the rate of meiosis, frequency of bivalent types, and frequency of interstitial and distal or terminal chiasmata per genome length were observed between A. tetradactyla and the two congeneric species J. jaculus and J. orientalis. Differences of these parameters among individuals within each species are also discussed in detail.

Standard versus low-level anticoagulation combined to low-dose dipyridamole after mitral valve replacement.

BACKGROUND: Although the addition of 300 mg dipyridamole to oral anticoagulants has been shown to decrease thromboembolic events after cardiac valve replacement, reports of combined therapy were few and some showed significant dipyridamole-related side effects and intolerance. The aim of this study was to compare the clinical effect of a standard monotherapy (targeting an international normalized ratio - INR - between 2.5 and 3.5) to a less intensive regimen (targeting an INR between 2 and 2.5) combined to a small dose of dipyridamole (225 mg/day). METHODS: Between January 1990 and December 1998, 486 young rheumatic patients with a St Jude mitral valve prosthesis were assigned to follow either standard monotherapy (294 patients) or low-level combined therapy (192 patients). Phenindione has been the anticoagulant of choice. Up to a maximum daily dose of 100mg, patients failing to achieve their target INR range were shifted to warfarin therapy. Prothrombin time was checked monthly and asymptomatic patients with a too low or a too high INR (<1.3 or >5) were briefly hospitalized for INR control. Complete blood picture, renal and hepatic profiles and full echocardiographic study were done biannually. RESULTS: With the exception of a significantly larger left atrium in patients on low-level combined therapy (P=0.001), both groups were comparable as regards to age and sex distribution, number of patients with atrial fibrillation, left atrial thrombus and history of stroke. Patients were monitored for 1712.6 pt yr and follow-up was 96.7% complete. No phenindione-related complications were observed (mean dose 62.3+/-21.4 mg), 20 patients (4.1%) had failed to achieve their target INR range and were switched to warfarin and only three patients (1.6%) had tolerable dipyridamole-related side effects. Compared to standard monotherapy, patients on low-level combined therapy showed significantly lower annualized rates: thromboembolism (1.6 vs 0.43%: risk reduction 71%; P=0.05), thromboembolism and hemorrhage (2.7 vs 0.7%: risk reduction 72%; P=0.005), death due to valve thrombosis or stroke (1.17 vs 0. 14%: risk reduction 81%; P=0.04) as well as both non-fatal (3.3 vs 1. 57%: risk reduction 51%; P=0.04) and total late postoperative complications (5.35 vs 3.14%: risk reduction 40%; P=0.04); respectively. However, total late mortality (32 patients; 1.8% per pt yr) was comparable among both groups. CONCLUSION: Low-level anticoagulation with phenindione combined to low dosage of dipyridamole was clinically more effective than the higher standard monotherapy. With respect to the prescribed doses, both drugs were well tolerated by almost all patients. Use of dipyridamole did not influence overall patients' survival.

Laser stapedotomy.

Thirty-four ears with conductive hearing loss due to otosclerosis were operated upon using the laser stapedotomy technique. Audiological results were compared with the results of 316 non-laser stapedotomies. The post-operative air-bone gap, calculated as the difference between the post-operative air and bone conduction levels, was smaller with the laser stapedotomy group. Also, the bone conduction showed significant improvement with the use of laser. Significant sensorineural hearing loss was not found in any of the laser-treated patients. According to our results, we concluded that laser is of benefit in stapes surgery for improving the hearing results and minimizing the inner ear trauma.

Lipid and retinol contents in the milk of Egyptian mothers with normal and sick infants.

Mature breast milk was collected from Egyptian lactating mothers (N = 35) and was analyzed for its lipid, retinol and carotene contents. Mean values of 3.78 +/- 0.3%, 29.5 +/- 4.92 micrograms/100 g and 65.2 +/- 16.28 micrograms/100 g were obtained for lipid, retinol and carotene in the milk of mothers with normal infants. The milk of mothers with sick infants was inferior in its quality with respect to the lipid and retinol contents. Milk retinol level correlated significantly with the growth of the normal infants.

Study of the absorption of vitamin A oily preparation among school pupils from the rural.

Fasting and postabsorptive vitamin A level was studied in 55 school pupils aged 6-13 years, with giardiasis, ascaridiasis, or other parasites, both before and after their eradication with appropriate therapy; and in 6 pupils without parasites. Acceptable plasma vitamin A levels were detected in 20.7% of the cases. Mean fasting plasma vitamin A level among controls (Parasite-free) was 20.2 micrograms/dl. None of the parasitized pupils had acceptable mean plasma vitamin A concentrations. Prompt eradication of the giardia lead to significant improvement in the fasting plasma vitamin A concentration. Post absorptive vitamin A level above 100 micrograms/dl was detected in just one case. Post absorptive vitamin A level ranged between 31.5 and 67.7 in the rest, regardless of the type of parasite or treatment.