Neurophysiological and morphological responses to treatment with acetyl-L-carnitine in a sciatic nerve injury model: preliminary data.

We investigated the effects of acetyl-L-carnitine (ALCAR) on the recovery of sciatic nerve injuries in rats. Sprague Dawley rats were randomized to two groups: ALCAR treated (for 14 days) and control. Each group was divided into three subgroups: distal transection, proximal transection, and grafted. Distal latencies, amplitudes, and motor nerve conduction velocities were measured. In the third month, biopsies were taken and examined under light microscopy. Electrophysiological measurements demonstrated that regeneration occurred earlier and was better in the ALCAR group, particularly in the distal transection subgroup. Better results were obtained in the distal transection subgroup in terms of axonal regeneration compared with the proximal transection and grafted subgroups because the regenerating segment was shorter. ALCAR enhanced the quality of neural recovery at the different levels and in different types of repair, and led to a decline in nerve death.

Severe bone marrow failure due to valganciclovir overdose after renal transplantation from cadaveric donors: four consecutive cases.

Valganciclovir is an l-valyl ester pro-drug of ganciclovir that was initially used to treat cytomegalovirus (CMV)-associated retinitis in patients with human immunodeficiency virus. Currently, it is also indicated for the prevention of CMV disease in solid-organ transplantation. It is primarily eliminated via the kidneys through glomerular filtration and tubular secretion. Decreased renal function results in decreased drug clearance. Valganciclovir has been reported to cause usually mild to moderate hematologic adverse effects such as leukopenia, neutropenia, anemia, thrombocytopenia, and pancytopenia. Severe and fatal bone marrow depression has been described in 1 adult patient. Herein, we describe the cases of 4 patients with end-stage renal disease who underwent cadaveric renal transplantation and received valganciclovir prophylaxis for CMV at a standard dose of 900 mg/d despite persistant renal failure. This therapy resulted in severe bone marrow failure after 18 to 20 days in all 4 patients, with fatal infections in 2 patients. This report demonstrates the in vivo pharmacodynamics of valganciclovir overdose in terms of hematotoxicity in the setting of renal impairment. Valganciclovir, as its derivative ganciclovir, should be used cautiously in patients with renal impairment.

Wide excision and free flap reconstruction of two cases with adult form of Juvenile Hyalin Fibromatosis localized on the foot.

Juvenile Hyalin Fibromatosis (JHF) or systemic hyalinosis is a rare, sporadic or hereditary disorder characterized by skin lesions, gingival hypertrophy, muscle weakness, and flexion contractures of large joints. There is still dispute in its pathogenesis and treatment. We described two cases with adult form of Juvenile Hyalin Fibromatosis localized in the foot and discussed the local control we achieved by surgery.

Fusion of maxillary and mandibular alveolar process together with a median mandibular cleft: a rare congenital anomaly.

Congenital fusion of the maxillary alveolar process and mandible is a very rare entity. A one day old male newborn was referred to our clinic with a diagnosis of a 'absence of oral cavity'. Physical examination revealed that there was no mouth opening bilaterally in the posterior region due to maxillary and mandibular bone fusion; and in the front there was only 1 mm of mouth opening. Examination of the intraoral space could not be achieved. No other congenital anomaly was detected on general examination. The infant, who was fed via a nasogastric tube for 1 month, was operated on. An intra-oral device which separated maxillary and mandibular alveolar arches from each other was designed and used for 8 weeks to avoid recurrence of the fusion. An adequate mouth opening was obtained and the infant could be fed orally.

Malignant fibrous histiocytoma developing in a burn scar.

Malignant fibrous histiocytoma (MFH) which is usually originated from muscles and deep fascia and rarely from the subcutaneous tissue is the most common soft tissue sarcoma; and it frequently invades the extremities. Occurrence of this tumor on a burn scar of scalp is a very rare entity. In the literature, there were only four reported malign fibrous histiocytoma cases that originated from a burn scar but none of them was at the scalp region. A female patient complaining about a painful mass at the scalp region was admitted to our clinic twenty years after burning with hot water when she was 3 years old. Pathological and clinical features of this rapidly growing malignant fibrous histiocytoma were similar with the other cases reported before. After the diagnosis was clear as a pleomorphic storiform type of MFH, a wide tumor excision was done because of the high risk of local recurrence.