Transient Edema Research Articles

Irreversible Hemorrhagic Complication of Recurrent Posterior Reversible Encephalopathy Syndrome in a Patient with Systemic Lupus Erythematosus

A diagnosis of posterior reversible encephalopathy syndrome (PRES) is based on a combination of clinical symptoms including headache, altered alertness, abnormalities of visual perception, and seizure, and characteristic neuroimaging findings of transient white matter edema, mostly in the posterior parietal-temporaloccipital regions of the brain (1, 2). Conditions commonly associated with PRES include severe hypertension, eclampsia/ preeclampsia, immunosuppressive medications including cyclosporine and taclorimus, antineoplastic agents, and various cause of renal failure (3, 4). PRES as a complication of systemic lupus erythematosus (PRES-SLE) is not uncommon and neurologic or psychiatric abnormalities occur in up to two-thirds of patients with SLE (4). Usually PRES is reversible vasogenic edema in the posterior circuation territories, although atypical findings such as conversion to irreversible cytotoxic edema, hemorrhage, and enhancement have been described (3). And cytotoxic edema surrounded by extensive vasogenic edema resulted in poor outcome. We report a case of PRESSLE showing irreversible hemorrhagic transformation as a complication of recurrent PRES.

Prospective Multicenter Clinical Trial of a Minimally Invasive Temperature-Controlled Bipolar Fractional Radiofrequency System for Rhytid and Laxity Treatment

A minimally invasive fractional bipolar radiofrequency (FRF) was developed. To evaluate safety and efficacy of FRF in reducing face and neck rhytides and laxity. This prospective, open-label, multicenter clinical trial enrolled 100 subjects with mild to severe facial and neck rhytides and laxity at seven centers in a per-protocol analysis. One single-pass FRF treatment was administered through five 32g-needle electrode pairs at a preselected real-time fixed temperature of 62 to 78°C, energy duration for 3 to 5seconds, and impedance restrictions of 200 to 3,000Ohms, ensuring intradermal delivery. Five blinded dermatologists and plastic surgeons graded randomized standardized baseline and follow-up photographs of 53 and 42 subjects at 3- and 6-month follow-up intervals, respectively, using the Fitzpatrick wrinkle and Alexiades-Armenakas laxity scales. Subject assessments and adverse events were recorded in 100 subjects. Blinded evaluations revealed correct pre- and post-treatment identification in 100% of scored cases, mean improvement of 25.6% on the Fitzpatrick Wrinkle Scale and 24.1% on the Alexiades-Armenakas laxity scale at 6months, and 100% response rate for rhytides and 95% for laxity. Subgroup analysis revealed maximal rhytid reduction in the mean target temperature of 66.7, energy duration of 4.2seconds, and volume of denatured collagen ofmm(3) denatured collagen group. Adverse events included transient erythema, edema, and ecchymoses, resolving within 1 to 5days, and two incidents of temporary pinpoint depressions. More than 90% of subjects were satisfied or very satisfied. Real-time temperature-controlled FRF is a highly reproducible, safe, effective nonsurgical treatment of face and neck rhytides and laxity and provides important insights into neocollagenesis, neoelastogenesis, and clinical outcomes.

Abstract P4-16-08: INTRAOPERATIVE ELECTRON RADIOTHERAPY IN EARLY STAGE BREAST CANCER. A SINGLE-INSTITUTION EXPERIENCE

Abstract Background: Women with early stage disease not only have a better prognosis, but also have the opportunity to preserve their breasts. Despite the positive evidence and outcomes for breast-conserving therapy (BCT), many women are unable or unwilling to undergo 5–7 weeks of external-beam radiotherapy (EBRT). We report the results of a single-institution phase II trial of accelerated partial breast irradiation (APBI) using a single dose of intraoperative electron radiotherapy (IOERT) in patients with low risk early stage breast cancer. Methods and materials: From July 2006 to December 2009, 226 patients suitable for BCT were enrolled in a phase II trial with IOERT as radical treatment immediately after surgical resection. All patients had biopsy proven cancer. After the surgeon temporarily re-approximated the excision cavity, a dose of 21 Gy using IOERT was delivered to the tumor bed with a margin of 2 cm laterally. Results: No acute reactions were reported after irradiation. Three patients experienced a transient edema. In 7 others a haematoma was observed. No cases of liponecrosis were observed. With a mean follow-up of 49 months (range 31–66 months), only one case of local recurrence has been reported. The observed toxicity was considered acceptable. As to cosmetic results, at 6 months after the end of IORT, 71/226 patients (31.4.%) had a score of 2 for symmetry and contour (asymmetry exhibited by 1/3 or less of volume breast), while 19/226 (8.4%) had a score 3 (asymmetry greater than 1/3 of breast volume). These findings remained unchanged at the following examinations. No breast oedema, discoloration at site or scar prominence were observed. Discussion: IOERT has significant advantages compared to other post-operative APBI approaches. The surgical re-approximation of the tumor bed, combined with the high quality of electron beam radiation, generates substantially more uniform dose distributions. IOERT offers the advantage of an excellent delineation of the tumor bed under visual control and high sparing of normal tissue, including the skin. IOERT delivers a very high biologically dose at the time of the surgery, when residual tumor cells are more rapidly proliferating. IOERT is insensitive to chemotherapy sequencing since all of the radiation is given during the surgery. IOERT offers low-risk women the possibility of a one-day procedure to treat their cancer and preserve their breast. The results of our study are very encouraging compared with other series with IOERT or APBI. The absolute recurrence rate of 0.4% and the recurrence rate per year of 0.2% of the present study are lower compared to the ones from the largest series with IOERT ever published (3.6% and 1.2%, respectively) (1). Conclusion: APBI using a single dose of IOERT can be delivered safely in women with early, low risk breast cancer. A longer follow-up is needed to ascertain its efficacy compared to that of the current standard treatment of whole breast irradiation.

Tube cavoplasty using autologous vein grafts for resected inferior vena cava reconstruction

Reconstruction of inferior vena cava (IVC) defects after surgical resection of the IVC is associated with significant complications, such as venous thrombosis and graft infection. We herein report a new technique called "tube cavoplasty" that uses only autologous venous grafts to reconstruct IVC defects after resection of leiomyosarcomas of the IVC. The patient's own left internal jugular and left external iliac veins are procured independently and incised along their axes to create an independent venous patch that is approximated together to make a wider "tube" graft. The size and length of the "tube" graft perfectly matches the IVC defect. In this study, no complications associated with this new procedure were observed except for transient mild edema of the left leg. This new technique could be a valuable tool to reconstruct IVC defects, such as those that occur after resection of IVC tumors or IVC stenosis for Budd-Chiari syndrome.

A Phase 2 Trial of HQK-1001 (sodium 2,2-dimethylbutyrate), an Oral Fetal Globin Gene Inducer, in HbE-Beta Thalassemia in Thailand

AbstractAbstract 251Beta thalassemia intermedia (BTI) syndromes are characterized by globin chain imbalance, ineffective erythropoiesis, hemolytic anemia, and have no therapeutic approved for the underlying pathology. Higher fetal globin (HbF) expression can compensate for beta globin deficiency, reduce globin chain imbalance, and ameliorate phenotype within the same genotypes. HQK-1001 (HemaQuest Pharmaceuticals, San Diego, CA) is an orally bioavailable, non-cytotoxic, short-chain fatty acid derivative which induces fetal globin expression in multiple experimental models. In thalassemic erythroid progenitors in vitro, HQK-1001 prolongs STAT-5 phosphorylation and increases expression of the pro-survival protein Bcl-xL. In a Phase I/II dose-escalation trial in BTI, HQK-1001 administered at 10, 20, 30, and 40 mg/kg/day for 8 weeks was well–tolerated, demonstrated a t½ of 9–11 hours, and treatment resulted in an increase in HbF and total hemoglobin (Hgb), with best results observed at 20 mg/kg.This open-label Phase 2 trial evaluated HQK-1001 administered orally at 20 mg/kg once daily for 26 weeks in adult patients with HbE-β0 thalassemia (NCT01609595). Ten subjects were enrolled, ages 20–36 years, including 7/10 female and 5/10 splenectomized subjects. The beta globin molecular mutations of the subjects, in addition to Codon 26 (G-A), included Codon 41/42 (-TTCT), Codon 17 (A-T), Codon 110 (T-C), and IVS I-I (G-T). At the time of this analysis, 9 of 10 subjects have completed at least 20 weeks of dosing. HbF has increased in all subjects above baseline levels by a mean of 10% (range 4.3% to 20.9%) and total HbF has increased by a mean of 1.07 g/dL, (range 0.52–2.38 g/dL, with positive changes in total HbF observed in 9/10 subjects. Total Hgb has increased by >0.5 g/dL above baseline (mean of 1.27 g/dL, range 0.7 to 2.2 g/dL) in 3 subjects after 3 to 5 months of dosing. Treatment was well-tolerated. There have been no severe drug-related adverse events, no serious adverse events, and no clinically relevant laboratory abnormalities. One subject developed transient proteinuria and edema without changes in renal function 3 weeks following an episode of pharyngitis. This ongoing trial demonstrates consistent induction of fetal globin expression by HQK-1001 at a well-tolerated dose level in subjects with HbE-beta thalassemia. Disclosures:Fucharoen:HemaQuest Pharmaceuticals: Research Funding. Perrine:HemaQuest Pharmaceuticals: Equity Ownership, Patents & Royalties.

An unusual cause of death: spontaneous urinary bladder perforation

Spontaneous urinary bladder perforation is a rare and life-threatening condition similar to traumatic and iatrogenic perforation. The connection with the underlying bladder damage due to previous radiotherapy, inflammation, malignancy, obstruction, or other causes can be found in almost all cases. The symptoms are often nonspecific, and misdiagnosis is common. Here, we present a case of spontaneous urinary bladder perforation due to bladder necrosis in a diabetic woman. She presented to the emergency department with abdominal pain. Exploratory laparotomy was performed by surgeons and revealed necrosis of the anterior and lateral walls of the urinary bladder. Microscopic examination revealed necrotic changes throughout the bladder wall. Ghost-like cellular outlines were compatible with coagulative necrosis. Clusters of bacteria were also present in some necrobiotic tissues. Malignant cells were not present. It appears probable that the infection was due to local interference with the blood supply (arterial, capillary, or venous) combined with the systemic metabolic upset that led to the bladder condition. In our case, we observed partial necrosis of the bladder rather than distortion of the entire blood supply to the bladder as consequences of the microvascular effects of diabetes. Urinary bladder perforation must be considered in the differential diagnosis of patients presenting with free fluid in the abdomen/peritonitis, decreased urine output, and hematuria, and in whom increased levels of urea/creatinine are detected in serum and/ or peritoneal fluid aspirate.

Transient Soft-Tissue Edema Associated with Implantation of Increasing Doses of rhBMP-2 on an Absorbable Collagen Sponge in an Ectopic Rat Model

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is an osteoinductive protein. However, soft-tissue edema adjacent to the site of rhBMP-2 implantation has been reported. This animal study was designed to examine soft-tissue edema associated with increasing rhBMP-2 doses with implantation on an absorbable collagen sponge (ACS) and with injection directly into muscle. Thirty-six Lewis rats received intramuscular implantation of rhBMP-2 on an ACS (Part I) or intramuscular injection of rhBMP-2 solution (Part II). Part-I sites received rhBMP-2/ACS at doses of 0 μg, 30 μg (normal), 129 μg (mid), or 450 μg (high). Part-II sites received rhBMP-2/ACS or rhBMP-2 intramuscular injection at doses of 10 μg (normal) or 150 μg (mid). A previous rat model showed 10 μg to be 100% effective at inducing osseous spinal fusion. In our study, T2-weighted magnetic resonance imaging (MRI) was performed at two and seven days to assess edema volume, and statistical comparisons were carried out with analysis of variance (ANOVA). Cellular response, vascularity, and ossification were examined histologically. Quantitative MRI demonstrated similar peri-implant edema volumes in the control (buffer on an ACS) and normal-dose rhBMP-2 groups. Higher doses resulted in increased edema volume. Edema decreased significantly from two to seven days. Similar capillary densities were observed in all rhBMP-2 groups at two days, and there was dose-dependent increased ossification at seven days. Compared with the rhBMP-2 injection, implantation of the rhBMP-2/ACS resulted in increased edema. This edematous response was transient in all groups. Minimal or no ossification occurred after the rhBMP-2 injections. Transient peri-implant soft-tissue edema occurred in a dose-dependent manner following implantation of rhBMP-2/ACS in this rat model. The normal dose of rhBMP-2/ACS produced edema similar to that in the controls. Finally, rhBMP-2 solutions injected directly into muscle resulted in minimal soft-tissue edema.

Intraoperative electron radiotherapy in early-stage breast cancer: A report on 226 patients.

143 Background: We report the results of a single-institution phase II trial of accelerated partial breast irradiation (APBI) using a single dose of intraoperative electron radiotherapy (IOERT) in patients with low-risk early-stage breast cancer. Methods: From July 2006 to December 2009, 226 patients suitable for BCT were enrolled in a phase II trial with IOERT as radical treatment immediately after surgical resection. All patients had biopsy-proven cancer. After the surgeon temporarily re-approximated the excision cavity, a dose of 21 Gy using IOERT was delivered to the tumor bed with a margin of 2 cm laterally. Results: No acute reactions were reported after irradiation. Three patients experienced a transient edema. In 7 others a haematoma was observed. No cases of liponecrosis were observed. With a mean follow-up of 49 months (range 31-66 months), only one case of local recurrence has been reported. The observed toxicity was considered acceptable. As to cosmetic results, at 6 months after the end of IORT, 71/226 patients (31.4.%) had a score of 2 for symmetry and contour (asymmetry exhibited by 1/3 or less of volume breast), while 19/226 (8.4%) had a score 3 (asymmetry greater than 1/3 of breast volume). These findings remained unchanged at the following examinations. No breast oedema, discoloration at site or scar prominence were observed. Conclusions: IOERT offers the advantage of an excellent delineation of the tumor bed under visual control and high sparing of normal tissue, including the skin. IOERT delivers a very high biologically dose at the time of the surgery, when residual tumor cells are more rapidly proliferating. IOERT is insensitive to chemotherapy sequencing since all of the radiation is given during the surgery. The absolute recurrence rate of 0.4% and the recurrence rate per year of 0.2% of the present study are very encouraging. APBI using a single dose of IOERT can be delivered safely in women with early, low-risk breast cancer. A longer follow-up is needed to ascertain its efficacy compared to that of the current standard treatment of whole breast irradiation.

Control of Arthritis Pain with Anti–Nerve-Growth Factor: Risk and Benefit

Arthritis is characterized by pain and inflammation. Recently, attention has been focused on nerve-growth factor (NGF), a neurotrophin that is a key regulator of peripheral nociception because it mediates overexpression of proinflammatory neuron-derived molecules such as substance P, serotonin, and calcitonin gene-related peptide. Antibodies have been generated for NGF and its receptor that are effective in reducing pain in preclinical pain models, and clinical trials in patients with advanced knee and hip osteoarthritis and low-back pain. Results show pain reduction is rapid and sustained. Adverse events with anti-NGF included transient paraesthesia and edema, rapidly progressive OA, and, in a small number of patients treated with both anti-NGF and nonsteroidal anti-inflammatory drugs, osteonecrosis. Inhibition of the NGF-stimulated nociceptive pathway seems to be effective; however, the adverse effects require further investigation.

Isolated Pons Involvement in Posterior Reversible Encephalopathy Syndrome in a Patient with Chronic Renal Insufficiency: Case Report and Literature Review

posterior reversible encephalopathy syndrome (pres) is characterized by headache, confusion, visual disturbances, and seizures [1]. Transient vasogenic edema occurs predominantly within the posterior circulation regions. similar clinical findings are present regardless of the cause. The syndrome can rapidly resolve after proper management. However, pres with only brain stem involvement has been uncommonly described and is usually associated with hypertension [2]. We herein describe a patient with pres who suffered from chronic renal insufficiency and in whom the pons was solely involved. We also reviewed the literature to investigate the potential pathophysiological mechanism of pres.

Analysis of resident-performed manual small incision cataract surgery (MSICS): an efficacious approach to mature cataracts

To examine and improve outcomes of resident-performed manual small incision cataract surgery (MSICS) cases via analysis of visual recovery, intraoperative adverse events, and early postoperative course. Particular focus was directed toward mature cataracts extracted by MSICS. A retrospective review was performed to identify MSICS cases performed by resident surgeons unfamiliar with the technique (initial ten cases) in an academic setting. Preoperative history, intraoperative adverse events, and postoperative course were reviewed. Of 30 cases identified, mean preoperative acuity was 1.8 ± 0.9 logMAR units (Snellen equivalent = 20/1262) improving to 0.20 ± 0.35 logMAR units (20/31) at final follow-up (p < 0.0001). Mean follow-up was 22.1 ± 19.0 days. The most frequent intraoperative adverse events were wound leak requiring intraoperative suturing (33 %), vitreous loss (6.7 %), and capsulorhexis radialization (6.7 %). Transient cornea edema was the most frequent (56.7 %) early postoperative minor complication. Two major complications occurred that required wound revision in one eye and iridoplasty in one eye. Of the 30 eyes undergoing surgery, 19 were noted to have mature cataracts. In this subset, mean acuity was 2.25 ± 0.64 logMAR units (20/3557) improving to 0.28 ± 0.42 logMAR (20/38) at final follow-up (p < 0.0001). Complications were similar in nature and frequency to the entire population in this subgroup. Supervised resident MSICS cataract surgery can result in excellent anatomic and visual outcomes. Appropriate wound construction is a frequently encountered difficulty, so particular attention should be directed to this step by both trainers and trainees.

External sclerostomy with the femtosecond laser versus a surgical knife in rabbits.

To experimentally compare the external sclerostomy produced using a femtosecond laser with that made by a surgical knife and to evaluate the healing patterns, efficacy and technical advantages of femtosecond laser sclerostomy. In a prospective randomized, controlled, masked-observer study, 10 pigmented rabbits underwent external sclerostomy with a femtosecond laser in the right eye; 10 additional rabbits underwent sclerostomy with a surgical superblade in the right eye. Clinical characteristics, which included bleb morphology and intraocular pressure, were recorded for 1 month after surgery. Six additional rabbits underwent external femtosecond laser sclerostomy in the right eye and mechanical sclerostomy in the left eye and were killed at day 14 after surgery. Histologic staining, immunohistochemistry and scanning electron microscopy were subsequently performed to assess the morphology of the filtering fistula. The titanium-sapphire femtosecond laboratory laser was operating at a repetition rate of 1 kHz, 0.4 mJ pulse energy, a central wavelength of 800nm and a pulse duration of 50 femtoseconds. Mann-Whitney and Kaplan-Meier tests were used for statistical analysis. Successful complete sclerostomy was achieved in each laser-treated eye which was hit only once by the laser. The laser treated time was approximately 15s-16s. In the laser-treated group (n=16), 2 eyes (12%) developed mild hyphema at the site of entry and 8 eyes (50%) showed transient edema in the corneal periphery adjacent to the laser impact zone. The differences between the groups in duration of function blebs and pressure reduction were statistically significant (P=0.025 and 0.016, respectively). The success rate of the laser-treated group was significantly higher than the knife group (P=0.005). Histologically, the subconjunctival connective tissue was loosely arranged with partially patent sclerostomy in the laser-treated eyes at postoperative day 14. This contrasted with the completely scarred sclerostomy tract in the knife group. The mean numbers of fibroblasts and new vessels as well as the amount of new collagen deposition at bleb site were significantly decreased in the laser group (P=0.045, 0.013 and 0.036, respectively). The current study demonstrates that external femtosecond laser sclerostomy may offer a safe and effective alternative for the minimally invasive surgical management of glaucoma.

Topical application of 5-aminolevulinic acid followed by 595-nm pulsed dye laser irradiation for the treatment of recalcitrant port-wine stains: A primary study

Objective: To evaluate the effectiveness and safety of topical application of 5-aminolevulinic acid (ALA) followed by pulsed dye laser (PDL) irradiation for the treatment of recalcitrant port-wine stain (PWS). Methods: Thirty-five patients (19 females and 16 males) with recalcitrant PWS were treated with topical application of 20% ALA and then irradiated with a 595-nm PDL (energy density of 6.5–9.0 J/cm2 and pulse duration of 6 or 10 ms) at 6–8 weeks intervals. Clinical improvement of lesions was evaluated by comparing photographs of lesions at baseline and 2 months after the last treatment. Results: Topical ALA spreading followed by irradiation with a 595-nm PDL improved PWS in 21 out of 35 patients who were previously recalcitrant to PDL treatment alone. Side effects were limited to transient erythema, vesicle formation, edema and mild purpura with no obvious subsequent scarring or undesirable pigment changes. Conclusion: The topical application of ALA followed by irradiation with a 595-nm PDL is an effective and safe treatment for PWS recalcitrant to PDL therapy alone.

Transient cytotoxic edema caused by hypoglycemia: follow-up diffusion-weighted imaging features

Hypoglycemia manifests as hemiparesis, mimicking stroke. Diffusion-weighted MRI (DWI) is a useful method to detect early brain injury in acute ischemia, but is less well known in hypoglycemia-induced hemiparesis [1–3]. Brain changes due to hypoglycemia are reversible, but irreversible changes can occur if not treated promptly. In the literature, there are limited reports about DWI features of transient hypoglycemia in which diffusion correction is shown starting from 12 h to 2 or 3 days following correction of hypoglycemia. We presented a case of hypoglycemic encephalopathy in which diffusion restriction almost rapidly resolved in 2 h following glucose infusion, probably due to the patient's young age.

Triazolam, obesity and non cardiac pulmonary edema

Summary Introduction Triazolam belongs to the group of benzodiazepines and may have side effects on the respiratory system which include not only respiratory depression, but also transient benign non cardiac pulmonary edema. Case report A 52 year old obese woman developed pulmonary edema after she was taking triazolam for almost two weeks without any other medications. All possible cardiogenic and non cardiogenic causes were excluded. The condition was severe enough to require non invasive ventilation. Discussion This case differs from the other report of triazolam associated non cardiac pulmonary edema for its severity requiring non invasive ventilation. The pathogenetic mechanism is unknown. Despite the lack of objective evidence to explain pulmonary venous hypertensive changes in our case , we want to advice that triazolam should be used with caution in obese patients, as obesity might aggravate this described drug adverse reaction.

927 DYNAMIC SENTINEL LYMPH NODE BIOPSY AT THE TIME OF PRIMARY SURGERY FOR PENILE CANCER; IMPACT ON MORBIDITY AND OUTCOME

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease III1 Apr 2012927 DYNAMIC SENTINEL LYMPH NODE BIOPSY AT THE TIME OF PRIMARY SURGERY FOR PENILE CANCER; IMPACT ON MORBIDITY AND OUTCOME Srijit Banerjee, Muhammad Rafiq, Krishna Sethia, and Vivekanandan Kumar Srijit BanerjeeSrijit Banerjee Norwich, United Kingdom More articles by this author , Muhammad RafiqMuhammad Rafiq Norwich, United Kingdom More articles by this author , Krishna SethiaKrishna Sethia Norwich, United Kingdom More articles by this author , and Vivekanandan KumarVivekanandan Kumar Norwich, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1024AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Detecting micro metastases by DSNB offers a survival advantage in clinically node-negative (cN0) patients with penile cancer whilst potentially avoiding the morbidity of inguinal lymphadenectomy in patients with high-and intermediate-risk disease. The timing of DSNB has traditionally been as second stage following the primary surgery. However DSNB at the time primary surgery avoids additional morbidity. But the oncological safety and the impact on primary site are unknown. METHODS Data was collected prospectively over a 20 month period for patients who underwent surgery for penile cancer at a tertiary referral centre. DSNB is offered if the primary histology is >G2PT1 SCC and cN0 unless a gross infection at primary site. DSNB and primary surgery were done at the same sitting. Follow-up was by regular clinical examination and selective ultrasound FNA of groin. RESULTS 39 patients with an average age of 70years (range 43-93) underwent surgery for penile cancer.37 patients had penile length conserving surgery of which 2 had local recurrence and eventually 4 had total penectomy. 16 patients had lymph node surgery. The timing of surgery and type of lymph node surgery are listed in Table 1. Table 1. Details of lymphnode surgery Type of LN surgery Total no of groins (patients) LN surgery at the time of primary surgery As a second stage operation Bilateral DSNB 14(7) 12(6) 6(1) Bilateral DSNB + Validation MLND⁎⁎ 9(5⁎) 6(3) 3(2) Left DSNB 2(2) 2 0 MLND⁎⁎ 5(3) 0 5(3) ⁎ one patient had DSNB on right and MLND on the left ⁎⁎ Modified Lymph node dissection 3/6 patients who had combined primary and lymph node surgery had transient scrotal oedema. However it did not have an effect on the primary surgery (ie skin graft). With 4-20 months follow-up false negative rate is 0% so far. CONCLUSIONS DSNB is both minimally invasive and accurate and does not have the co morbidity of lymphadenectomy. Thus it is increasingly being adopted for management of clinically node negative moderate and high grade penile cancers. By performing the DSNB at the time of primary surgery we have avoided the risk of GA and further surgery. The initial data show that there are no false negative results by adopting this approach. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e377 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Srijit Banerjee Norwich, United Kingdom More articles by this author Muhammad Rafiq Norwich, United Kingdom More articles by this author Krishna Sethia Norwich, United Kingdom More articles by this author Vivekanandan Kumar Norwich, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Asymptomatic posterior reversible encephalopathy revealed by brain MRI in a case of axonal Guillain-Barré syndrome

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic syndrome characterized by headaches, encephalopathy, visual disturbances and seizures, with a transient vasogenic oedema on brain imaging. The lesions are predominantly but not exclusively located in the posterior circulation system. The most frequent aetiologies include hypertension, cytotoxic or immunosuppressive drugs, sepsis, eclampsia or preeclampsia [1]. Some cases of PRES are described in association with Guillain-Barre syndrome (GBS) [2]. We report the case of a young woman who presented with a GBS, dysautonomia, and a brain MRI suggesting PRES but lacking any encephalic symptom suggestive of that syndrome. We discuss the relationship between, PRES, GBS and dysautonomia.

Transient pulmonary edema following Adrenal Infarction in a patient with primary Anti-phospholipid syndrome

We report a patient with primary anti-phospholipid syndrome (APS) who developed pulmonary edema following sudden-onset pain in the left, lower back of the chest. Radiological examinations demonstrated fresh infarction of the left adrenal gland but no obvious thrombi in pulmonary arteries. The patient quickly recovered from pulmonary edema with anti-coagulation therapy alone. Primary APS may have caused adrenal infarction in the patient, leading to transient pulmonary edema via microthrombosis and/or excessive release of catecholamine.

Unilateral Thrombosis of a Deep Cerebral Vein Associated with Transient Unilateral Thalamic Edema

Symptoms of deep cerebral vein thrombosis (DCVT) are variable and nonspecific. Radiologic findings are essential for the diagnoses. In the majority of cases of deep internal cerebral venous thrombosis, the thalamus is affected bilaterally, and venous hypertension by thrombosis causes parenchymal edema or venous infarction and may sometimes cause venous hemorrhage. Intravenous injections of mannitol can be administered or decompressive craniectomy can be performed for reduction of intracranial pressure. The objectives of antithrombotic treatment in DCVT include recanalization of the sinus or vein, and prevention of propagation of the thrombus. Herein, the authors report DCVT which was successfully treated by low molecular weight heparin.

Much ado about nothing

Thirty-year-old woman with history of AIDS and anxiety presented with palpitations. Although clinically euvolemic, she was aggressively fluid resuscitated in lieu of sinus tachycardia. She developed unilateral pulmonary edema on account of left decubitus positioning and volume resuscitation. Given her normal cardiac, renal, and liver status, she spontaneously cleared the extra fluid, and the pulmonary edema resolved. This case highlights the importance of recognizing transient unilateral pulmonary edema and need for early radiographs to document clearance and prevent unnecessary testing.