Male-female differences in the risk of tuberculosis in dialysis patients.

AIM: To define any gender-related differences in the prevalence and risk for tuberculosis (TB) in hemodialysis (HD) patients. METHODS: All active TB cases were recorded during a 36-month follow-up of 272 (193 male and 79 female) HD patients. Entering the study, HD patients were tested with tuberculin and 2,4-dinitrochlorobenzene, and a cell-mediated immunity (CMI) index was estimated. Relative risks (RR) for TB were calculated considering subjects from the background general population as a reference group. The independent effect of age, BMI and tuberculin sensitivity was determined using Cox's proportional hazard model. RESULTS: Female HD patients presented significantly lower CMI indices and rates of positive Mantoux tests, but higher rates of DM, as compared to males. The male:female ratio in TB for the general and HD patients population was 1.8 and 0.6, respectively. There was a significantly lower TB prevalence in male as compared to female HD patients (7.7% vs. 11.3%), and a subsequent female predominance in risk for TB in those HD patients aged <49 and 50-69 years (M:F adjusted relative risk 0.67 and 0.53) was recorded. CONCLUSIONS: In contrast to the general population, there is a female predominance among dialysis TB patients younger than 70 years associated with the coexistence of DM. Female gender should always be considered as a risk factor when evaluating diabetic HD patients for active TB.

Cystic thymoma coexisting with vascular dysplasia.

We report the case of a 23-year-old female patient, who was admitted to our hospital because of aggravating pain in the right shoulder, right chest and ear accompanied by cough and dyspnea. Imaging revealed a soft tissue mass in the mediastinum in close relation with an additional large mass extending in the right upper thorax, right axilla and neck. The tissue obtained during surgery showed the former mass to be a cystic thymoma, being in contact with an extensive vascular dysplasia. The characteristic clinical presentation, the contribution of imaging, the results of operation, and the follow-up are rather unique. The review of the literature did not reveal similar cases.

Risk of tuberculosis in dialysis patients: association of tuberculin and 2,4-dinitrochlorobenzene reactivity with risk of tuberculosis.

BACKGROUND: Dialysis patients are at increased risk of tuberculosis (TB) and anergy due to attenuated cellular immunity. AIM: To define specific risks of TB in anergic and non-anergic dialysis patients. METHODS: A total of 272 dialysis patients were enrolled in this prospective study over a 36-month follow-up. Entering the study, participants had Mantoux and 2,4-dinitrochlorobenzene skin tests and their cell-mediated immunity (CMI)-index was estimated. Patients were classified as anergic (CMI-index

Spinocerebellar ataxia and hypergonadotropic hypogonadism associated with familial sensorineural hearing loss.

Cerebellar ataxia has been described as being associated with hypogonadism for almost 100 years. In the majority of cases, hypogonadism is hypogonadotropic. The association of cerebellar ataxia with hypergonadotropic hypogonadism is a rare genetic disorder with a recessive mode of inheritance. Cerebellar ataxia and hypogonadism can also occur associated with a large spectrum of additional clinical manfestations, including mental retardation, sensorineural deafness, choroidal dystrophy, ectodermal dysplasia and short stature, and polyneuropathy. We report the case of a woman with early-onset spinocerebellar ataxia, primary amenorrhea due to hypergonadotropic hypogonadism, and late-onset sensorineural hearing loss. Additional family members from the father's side are affected with late-onset hearing loss, suggesting a dominant mode of inheritance.

An asymptomatic pulmonary hilar mass: a case report.

Pulmonary vein varix is a rare benign abnormality, either congenital or acquired, usually presented without symptoms. It is most frequently discovered by chance on a chest radiograph, whereas computed tomography defines the special characteristics of the lesion. Angiography is considered the method of choice for final diagnosis. The authors present the first case of a patient with pulmonary vein varix accompanied by interatrial communication.

Asthmatic bronchitis for 2 years. A case report.

Longstanding asthmatic bronchitis, without evidence of underlying disease, occurring in middle-aged patients, is usually attributed to chronic obstructive pulmonary disease and is treated appropriately. We report a case of 2-year asthmatic bronchitis with recurrent attacks of wheezing, in a 60-year-old patient. He had three repeated hospitalizations, in different institutions, where he was treated for exacerbations of chronic bronchitis complicated by lower respiratory tract infections. During his final hospitalization, a tracheal hamartoma was found and removed, releasing him from his symptoms.

Ovulation induction with pulsatile gonadotropin-releasing hormone (GnRH) or gonadotropins in a case of hypothalamic amenorrhea and diabetes insipidus.

Hypothalamic amenorrhea is a treatable cause of infertility. Our patient was presented with secondary amenorrhea and diabetes insipidus. Cortisol and prolactin responded normally to a combined insulin tolerance test (ITT) and thyrotropin-releasing hormone (TRH) challenge, while thyroid-stimulating hormone (TSH) response to TRH was diminished, and no response of growth hormone to ITT was detected. Both luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels increased following gonadotropin-releasing hormone (GnRH) challenge. No response of LH to clomiphene citrate challenge was detected. Magnetic resonance imaging findings demonstrated a midline mass occupying the inferior hypothalamus, with posterior lobe not visible and thickened pituitary stalk. Ovulation induction was carried out first with combined human menopausal gonadotropins (hMG/LH/FSH) (150 IU/day) and afterwards with pulsatile GnRH (150 ng/kg/pulse). Ovulation was achieved with both pulsatile GnRH and combine gonadotropin therapy. Slightly better results were achieved with the pulsatile GnRH treatment.

Infantile hemangioendothelioma. A case report.

The case of a 3-month-old boy with a hepatic infantile hemangioendothelioma is reported. There was no previous history of disease and no symptoms, only an incidentally found abdominal mass. The case is presented as an example of establishing the diagnosis, deciding upon the treatment, and performing the follow-up using only non-invasive imaging techniques.

Diaphragmatic haemangioma. A case report.

The case of a 4-year-old patient with a diaphragmatic haemangioma is reported. There were no symptoms and the only clinical finding was prominent subcutaneous vessels on the abdominal wall. The lesion was revealed by imaging and was excised. The findings and the differential diagnosis are discussed.

Milk of calcium cysts masquerading as renal calculi.

Milk of calcium renal cysts contain a colloidal suspension of calcium crystals. By routine radiography and sonography in supine position this rare condition may be misinterpreted as renal lithiasis for which an unnecessary surgical intervention may be performed as it happened in our two cases that are presented here. Postoperatively, the characteristic finding of half-moon contour on upright abdominal plain views was lacking in one case, but in both cases computed tomography revealed the typical calcific suspension layering. However, upright plain views and computed tomography are not routinely performed in patients in whom a renal stone has initially been considered. This entity should be considered in the differential diagnosis of renal paracalyceal calcifications of obscured origin.

Anatomical variations of the human vestibular aqueduct. Part I. A radioanatomical study.

Variations in the size and shape of the human vestibular aqueduct were evaluated in 118 plastic casts of unselected specimens of human temporal bones. They were examined by conventional radiography and by high resolution CT. The degree of the mastoid and perilabyrinthine pneumatization was defined and classified into 3 types. The dimensions of the peripheral portion of the aqueduct were found to be related to the extent of the perilabyrinthine pneumatization.

Anatomical variations of the human vestibular aqueduct. Part II. A radioanatomical study.

The human vestibular aqueducts are classified into 3 types and into the types hyper-, normo- and hypoplastic. The types correspond with each other up to over 85%. For a better understanding of the radioanatomy and for the proper interpretation of radiograms, we describe the presence of a flat recess-like widening of the peripheral portion of the aqueduct, as well as other findings.

The proximal portion of the vestibular aqueduct. A radioanatomical investigation.

PURPOSE: To obtain information on the morphology of the proximal portion of the vestibular aqueduct. MATERIAL AND METHODS: One hundred plastic casts of temporal bone were examined with a dissection microscope at high magnifications in order to evaluate the proximal portion of the vestibular aqueduct. The difficulties in reproducing these minute structures were solved by light scanning photography. RESULTS: There is usually more than one paravestibular canaliculus (PVC) around the proximal portion of the vestibular aqueduct closely related to an intra-and a periaqueductal vascular network. An estimate was made of the number of PVCs and their widths measured. The origins of the PVCs at the wall of the vestibule were identified and their widths were measured. Numerous vascular sulci and impressions of a vascular network on the inside of the bony wall of the vestibule were revealed close to the internal aqueductal aperture. The pattern of the channels and the number of the paravestibular canaliculi were not influenced by the pneumatization of the temporal bone. CONCLUSION: The significance of these vascular structures and their influence on the radiographic reproducibility of the proximal portion of the vestibular aqueduct is discussed.

Anatomical variations of the tympanic and mastoid portions of the facial nerve canal. A radioanatomical investigation.

PURPOSE: To obtain information on the morphology of the tympanic and mastoid portions of the facial nerve canal, and on the appearance of unusual vascular channels and anomalies such as dehiscences. MATERIAL AND METHODS: One hundred and two temporal bone preparations were examined by conventional radiography to evaluate mastoid pneumatization. Of these, 73 were examined by high resolution CT in order to test the ability of the method to detect dehiscences in the bony wall of the tympanic portion of the canal and the accompanying channels along its mastoid portion. Subsequently produced plastic preparations were used to measure the length and width of these 2 portions of the facial canal. RESULTS: Our study reports observations on the three-dimensional morphology of the canal in the plastic casts. The study shows variations in the course and dehiscences of the tympanic portion. Additional bony channels along the mastoid portion are described. These results supplement those in previous investigations. CONCLUSION: The measurement results agree with those of previous investigations. The course of the tympanic portion is S-shaped and has an impression on its upper surface. High resolution CT reproduces dehiscences of the bony canal in a percentage similar to that of microscopical methods and in relevant sites. Pneumatization does not influence the dimensions of the 2 portions.

Anatomical shape of the airways in two different European populations. A radio-anatomical study of the airways.

Lateral radiographs of the airways were taken in 20 men and 24 women lying supine with the neck in the normal position. The mean configuration of the airways for men and women is presented in a standard coordinate system. The results (contours of the airways) are compared to those of a Swedish study since the same method was applied in order to find out, if the established model is valid for other populations. Significant differences were found between the two population groups as well as between males and females. This indicates both inter-racial and inter-sexual modification of the anatomical shape of the airways.

Dual-energy X-ray absorptiometry in rheumatoid arthritis: comparison between axial and appendicular skeleton findings.

Bone mineral density was measured by dual-energy x-ray absorptiometry (DXA) at the lumbar spine, both hips and distal radius in 10 postmenopausal patients with rheumatoid arthritis (RA). DXA values at the lumbar spine and distal radius were compatible with osteoporosis in all but 1 patient. Only 4 patients had osteoporosis of the hip, and 3 of these were over 65. Preliminary results over this small population suggest that in RA a correlation may be expected between DXA values in lumbar spine and distal radius, but not between either of these and the hip.

False aneurysm of splanchnic arteries--a scintigraphic pitfall.

A 99mTc-DTPA flow study fo the abdominal aorta in a 56-year old woman gave a false-positive image of an aneurysm at the site of the celiac axis or superior mesenteric artery.