Purely extradural cavernous hemangiomas of the spinal canal are extremely rare. Their occurrence at the lumbosacral level is a true exception. We describe a case of lumbosacral extradural hemangioma and review the behaviour and MR imaging characteristics of these lesions. Cavernous hemangioma should be considered in the differential diagnosis of an enhancing extradural periradicular mass causing chronic lumbar radiculopathy especially in fertile women. Lumbar extradural hemangiomas appear and behave differently, not only from intramedullary cavernous hemangiomas but also from extradural hemangiomas of other spinal locations.

Objectives

We investigated whether exposure to biomass fuel is a potential risk factor for chronic bronchitis and asthma among females in rural area in Van (east Turkey).

Methods

The effect of indoor pollution producing various respiratory symptoms was studied in 177 females. Of these, 90 were those who used biomass fuel and 87 were nonusers of biomass fuel. A part of the European Community Respiratory Health Survey quastionnaire and British Medical Research Council questionnaire were used.

Results

Asthma related symptoms (AS) (wheezing, and combination of wheezing without a cold and wheezing with breathlessness) were reported in 63.3% of those who used biomass fuel, and in 12.9% of nonusers (p<0.0001). The use of asthma medication was reported as 3.3% of biomass fuel users, and in 2.7% of nonuser (p>0.05). Long term cough and/or morning cough together with sputum (chronic bronchitis symptoms (BS) was reported as 58.9% in the user group, and 29.4% in the nonuser group (p<0.0001). Significant differences in AS and BS were found between biomass fuel user and nonuser groups in the rural area.

Conclusions

The results of this study showed a significant association between symptoms of chronic bronchitis-asthma and biomass fuel usage in females living in a rural area.

The mechanisms by which the immune response can eradicate gastric Helicobacter infection are unknown. We hypothesized that Helicobacter-induced activation of the complement system could promote both inflammation and eradication of Helicobacter from the stomach. In vitro studies demonstrated that Helicobacter felis activates complement in normal mouse serum but not in serum from Rag2−/− mice, indicating that H. felis activates complement through the classical pathway. Next, we infected complement-depleted wild-type control and interleukin-10-deficient (IL-10−/−) mice with H. felis. Helicobacter infection of wild-type mice elicited a mild, focal gastritis and did not alter serum complement levels. Infection of IL-10−/− mice with H. felis elicited severe gastritis. After the initial colonization, the IL-10−/− mice completely cleared Helicobacter from the stomach by day 8. In contrast to wild-type mice, H. felis-infected IL-10−/− mice had a marked increase in serum complement levels. Complement depletion of wild-type mice did not affect the intensity of gastric inflammation or the extent of Helicobacter colonization compared to that for the wild-type control mice. In contrast, complement depletion of Helicobacter-infected IL-10−/− mice decreased the severity of gastritis, decreased the Helicobacter-induced infiltration of neutrophils into the stomach, and delayed the clearance of bacteria. In vitro studies of stimulated splenocytes and neutrophils from IL-10−/− mice produced a twofold increase in complement production compared to that for wild-type mice. Pretreatment with IL-10 inhibited this increase. These studies identify a role for complement in the local immune response to gastric Helicobacter in IL-10−/− mice and suggest a role for IL-10 in the regulation of complement production.

ABSTRACT

A patient with an intraorbital hydatid cyst was treated successfully through a transmaxillary approach. Numerous procedures to remove intraorbital hydatid cysts are discussed.

Helicobacter pylori infection, which is always associated with gastritis, can progress to ulceration or malignancy. The diversity in clinical outcomes is partly attributed to the expression of virulence factors and adhesins by H. pylori. However, H. pylori may not have to adhere to the epithelium to cause gastritis. We hypothesize that outer membrane vesicles (OMV), which are constantly shed from the surface of H. pylori, play a role as independent activators of host cell responses. In this study, we found that low doses of OMV from cag PAI+ toxigenic and cag PAI− nontoxigenic strains increased proliferation of AGS gastric epithelial cells. At higher doses, we detected growth arrest, increased toxicity, and interleukin-8 (IL-8) production. The only strain differences detected were vacuolation with the toxigenic strain and higher levels of IL-8 production with OMV from the cag PAI− nontoxigenic strain. In summary, we suggest that constitutively shed OMV play a role in promoting the low-grade gastritis associated with H. pylori infection.

In this study, the effect of Lactobacillus paracasei (NCC 2461), Lactobacillus johnsonii (NCC 533) and Bifidobacterium lactis Bb12 (NCC 362) on the induction and maintenance of oral tolerance to bovine β-lactoglobulin (BLG) was investigated in mice. Germfree mice were monocolonized with one of the three strains before oral administration of whey protein to induce tolerance. Mice were then injected with BLG and sacrificed 28 or 50 days after whey protein feeding for humoral and cellular response measurement. Conventional and germfree mice were used as controls. Both humoral and cellular responses were better suppressed in conventional mice than in germfree and monoassociated mice throughout the experiment and better suppressed in L. paracasei-associated mice than in mice colonized with B. lactis or L. johnsonii. The latter two mono-associations suppressed humoral responses only partially and cellular responses not at all. This study provides evidence that probiotics modulate the oral tolerance response to BLG in mice. The mono-colonization effect is strain-dependant, the best result having been obtained with L. paracasei.

Objectives:

To investigate the prevalence of possible hearing impairment and hypertension in long distance bus drivers compared to the city bus drivers in Abha city.

Methods:

This was a cross-sectional study involving 62 long distance bus drivers and 46 city bus drivers from October 2001 to March 2002. A specially-designed questionnaire was administered to the drivers to explore some of their socioeconomic backgrounds. A pure tone air conduction audiometry and blood pressure measurements were performed.

Results:

Long distance bus drivers’ workload is significantly higher than that of city drivers (total weekly hours 64.0±14.3 compared to 46.7±5.5). Hearing impairment was significantly more among long distance drivers in the frequencies of 250, 500, 1000 and 2000 Hz especially in the left ear even after age corrections. The prevalence of mild hearing loss and hypertension were also higher among the long distance drivers (19.4% vs 4.5% and 38.7% vs 13% respectively).

Conclusion and recommendations:

This study showed more hearing affection and a higher prevalence of hypertension among long distance bus drivers than their counterparts operating in the city. Their hearing acuity should be tested before they start work and regularly afterwards. The stresses and strains of the job should be further studied and relieved; and regular health checks including blood pressure monitoring are to be instituted.

An early requirement of the UK's Diabetes National Service Framework is enumeration of the total affected population. Existing estimates tend to be based on incomplete lists. In a study conducted over one year in North Liverpool, we compared crude prevalence rates for type 1 and type 2 diabetes with estimates obtained by capture–recapture (CR) analysis of multiple incomplete patient lists, to assess the extent of unascertained but diagnosed cases. Patient databases were constructed from six sources—a hospital diabetes centre; general practitioner registers; hospital admissions with a diagnosis of diabetes; a hospital diabetic retinal clinic; a research list of patients with diabetes admitted with stroke; and a local children's hospital. Log linear modelling was used to estimate missing cases, hence total prevalence.

The crude prevalence of diabetes was 1.5% (95% confidence interval [CI] 1.41, 1.52), compared with a CR-adjusted rate of 3.1% (CI 3.03, 3.19). Age-banded CR-adjusted prevalence was always higher in males than in females and the difference became more pronounced with increasing age. Among males, CR-adjusted prevalence rose from 0.4% at age 10–19 years to 18.3% at 80+ years; in females the corresponding figures were 0.4% and 9.3%.

The gap between crude and CR-estimated prevalence points to a rate of 'hidden diabetes' that has substantial implications for future diabetes care.

Objective:

To study the clinical, EEG and CT profile in a hospital population of adolescents with newly diagnosed recurrent seizures.

Methods:

The clinical profiles obtained from history including detailed descriptions of the seizures, examination, electroencephalographic (EEG) and computed tomography (CT) findings were recorded prospectively for all 14 to18-year-old patients who were referred to the electrodiagnostic service at King Fahd Hospital of the University, Al- Khobar, Eastern Province, Saudi Arabia from 1st January 1996 to 31st December 1997. The data were entered into a standard dbase file and analyzed using a personal computer. The results were compared with 2 previous concomitant subsets of data obtained from 263 children ≤13 years (72%) and 73 adults > 18 years (20%) over the same study period.

Results:

Twenty-nine patients (14 males and 15 females, a mean age of 15.7 years) with newly diagnosed recurrent seizures were studied. A positive family history of seizures was found in 10.3%. The main seizure types were partial in 11 (37.9%), partial with secondary generalization in 6 (20.7%) and generalized in 12 (41.4%). The types of epileptic syndromes included localization-related 15 (51.7%), generalized 12 (41.4%) and undetermined 2 (16.9%). The EEG was abnormal in 21 (72.4%) with epileptiform activity, focal in 11 (52.4%), generalized in 9 (42.8%) and none-epileptiform activity in 1 (4.8%). The cranial CT findings were normal in 21 patients (72.4%) and abnormal in 8 (27.6%) patients, with focal lesions in 6 (75%) and generalized cerebral atrophy in 2 (25%). The frequency of adolescents presenting with newly-diagnosed seizures was 8% of the total study population of 365 patients including children and adults.

Conclusion:

The results showed that partial and partial with secondary generalization seizures and the localization-related epileptic syndrome are the most frequent seizure and epileptic syndrome types in adolescents. The least frequent of newly diagnosed seizures in adolescents compared to children and adults confirms the bimodality of peak frequency in the young and old that has been observed in the west.

The major virulence factors of toxigenic Vibrio cholerae are cholera toxin (CT), which is encoded by a lysogenic bacteriophage (CTXΦ), and toxin-coregulated pilus (TCP), an essential colonization factor which is also the receptor for CTXΦ. The genes for the biosynthesis of TCP are part of a larger genetic element known as the TCP pathogenicity island. To assess their pathogenic potential, we analyzed environmental strains of V. cholerae carrying genetic variants of the TCP pathogenicity island for colonization of infant mice, susceptibility to CTXΦ, and diarrheagenicity in adult rabbits. Analysis of 14 environmental strains, including 3 strains carrying a new allele of the tcpA gene, 9 strains carrying a new allele of the toxT gene, and 2 strains carrying conventional tcpA and toxT genes, showed that all strains colonized infant mice with various efficiencies in competition with a control El Tor biotype strain of V. cholerae O1. Five of the 14 strains were susceptible to CTXΦ, and these transductants produced CT and caused diarrhea in adult rabbits. These results suggested that the new alleles of the tcpA and toxT genes found in environmental strains of V. cholerae encode biologically active gene products. Detection of functional homologs of the TCP island genes in environmental strains may have implications for understanding the origin and evolution of virulence genes of V. cholerae.

Background

Cefoperazone has not been reported to cause vasculitic complications before. Here, we report a case of hypersensitivity vasculitis associated with cefoperazone/sulbactam.

Case presentation

A 13-year-old girl with appendicitis developed hypersensitivity vasculitis on the fifth day of cefoperazone/sulbactam therapy. Hypersensitivity vasculitis resolved gradually after removal of the agent on the seventh day and did not recur. Although hypersensitivity vasculitis has multiple causes, coexistence of hypersensitivity vasculitis and cefoperazone treatment, and the quite resolution of the disease after removal of the drug, strongly favours a causative relationship.

Conclusion

To our knowledge, this is the first report of a hypersensitivity vasculitis associated with cefoperazone.

Objective: To compare ertapenem therapy with piperacillin–tazobactam therapy for the management of acute pelvic infections.

Methods: In a multicenter, double-blind study, 412 women with acute pelvic infection were assigned to one of two strata, namely obstetric/postpartum infection or gynecologic/postoperative infection, and were then randomized to ertapenem, 1 g once a day, or piperacillin–tazobactam, 3.375 g every 6 hours, both administered intravenously.

Results: In total, 163 patients in the ertapenem group and 153 patients in the piperacillin–tazobactam group were clinically evaluable. The median duration of therapy was 4.0 days in both treatment groups. The most common single pathogen was Escherichia coli . At the primary efficacy endpoint 2–4 weeks post therapy, 93.9% of patients who received ertapenem and 91.5% of those who received piperacillin–tazobactam were cured (95% confidence interval for the difference, adjusting for strata, –4% to 8.8%), indicating that cure rates for both treatment groups were equivalent. Cure rates for both treatment groups were also similar when compared by stratum and severity of infection. The frequency and severity of drug-related adverse events were generally similar in both groups.

Conclusions: In this study, ertapenem was as effective as piperacillin–tazobactam for the treatment of acute pelvic infection, was generally well tolerated, and had an overall safety profile similar to that of piperacillin–tazobactam.

The pharmacodynamics of propranolol were studied in 12 cirrhotic Malay patients. Fifteen healthy Malay volunteers were selected and several clinical parameters were obtained. The effects of three doses of propranolol in reducing the heart rate (HR) of these patients were observed to be significantly different. These differences were seen at dosing of 10 mg vs 20 mg and 10 mg vs 30 mg (P<0.001 and P<0.01, respectively). However, no significant difference was seen for doses between 20 mg vs 30 mg. At 20 mg the reduction in HR is more pronounced than the effect seen with the other two doses. The effects of propranolol in reducing Vmax and Vmean of portal vein blood flow were found to be not significant at doses of 10 mg vs 30 mg, but between 10 mg vs 20 mg and 20 mg vs 30 mg there was significant difference (P<0.05 and P<0.01, respectively). Reduction of Vmax of more than 10% of baseline was achieved at doses of 10 mg and 20 mg. However, at a dose of 20 mg a more significant reduction was observed than at a dose of 10 mg. Dose-concentration-effect relationship was seen to be significantly different between HR reduction and propranolol concentration of the three steady-state levels (P<0.001). Similar results were obtained with Vmax and Vmean. The Vmax was found to be a reliable parameter for the assessment of therapeutic effect of the drugs in conferring changes in portal haemodynamics of liver cirrhotic patients. Further, Child-Pugh score is thought to be an important supporting factor in evaluating prognosis. The results of this pharmacodynamics studies suggest that the optimal dose of propranolol may be 20 mg propranolol thrice daily for cirrhotic Malay patients.